RESUMO

BACKGROUND: Cervical cancer progresses slowly, increasing the chance of early detection of pre-neoplastic lesions via Pap exam test and subsequently preventing deaths. However, the exam presents both false-negatives and false-positives results. Therefore, automatic methods (AMs) of reading the Pap test have been used to improve the quality control of the exam. We performed a literature review to evaluate the feasibility of implementing AMs in laboratories. METHODS: This work reviewed scientific publications regarding automated cytology from the last 15 years. The terms used were "Papanicolaou test" and "Automated cytology screening" in Portuguese, English, and Spanish, in the three scientific databases (SCIELO, PUBMED, MEDLINE). RESULTS: Of the resulting 787 articles, 34 were selected for a complete review, including three AMs: ThinPrep Imaging System, FocalPoint GS Imaging System and CytoProcessor. In total, 1 317 148 cytopathological slides were evaluated automatically, with 1 308 028 (99.3%) liquid-based cytology slides and 9120 (0.7%) conventional cytology smears. The AM diagnostic performances were statistically equal to or better than those of the manual method. AM use increased the detection of cellular abnormalities and reduced false-negatives. The average sample rejection rate was ≤3.5%. CONCLUSION: AMs are relevant in quality control during the analytical phase of cervical cancer screening. This technology eliminates slide-handling steps and reduces the sample space, allowing professionals to focus on diagnostic interpretation while maintaining high-level care, which can reduce false-negatives. Further studies with conventional cytology are needed. The use of AM is still not so widespread in cytopathology laboratories.

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RESUMO

The retrospective study on cervico-vaginal smears analyzed by Papanicolaou (Pap) test at Instituto Adolfo Lutz Division of Pathology, during the period from 2003 to 2008, was carried out. The diagnoses of pre-neoplasic and neoplasic lesions on Pap smears were analyzed, according to the age groups distribution. Of the 222,024 analysed samples, 3,674 (1.65%) were classified as unsatisfactory, 206,439 (92.98%) were negative and 11,911 (5.36%) presented abnormal cytology diagnoses. Of those with abnormal cytology, 6,437 (54.04%) were classified as ASC-US, 210 (1.76%) as ASC-H, 3,264 (27.40%) as LSIL, 1,279 (10.74%) as HSIL, 131(1.10%) as SCC and 552 (4.63%) as AGC-US, 23 (0.19%) as AGC-H, 7 (0.06%) as AIS, and 8(0.07%) were diagnosed as ADENOCA. The distribution of the squamous and glandular intraepithelial lesions diagnosis in the age group ranging at 5-year intervals, showed the major frequency of LSIL among younger women (15-25 years of age), and the diagnoses of ASC-US, ASC-H, AGC-US, HSIL, SCC and ADENOCA among >50 year- old women. The glandular variations as AGC-H and AIS occurred in women at of 30-34 and 45-49 age groups. Two (0.16%) women with HSIL were under 14 years of age, and 51 (3.99%) were from 15 to 19 years old. This study emphasizes the relevance in implementing the educational campaigns, the patients screening and follow-up protocols for assuring the improvem

No presente estudo foi realizado o levantamento retrospectivo de diagnóstico citopatológico das lesões pré-neoplásicas e neoplásicas pela método de Papanicolaou e sua distribuição por faixa etária das mulheres atendidas no período de 2003a 2008. Das 222.024 amostras analisadas, 3.674 (1,65%) foram classificadas como insatisfatórias, 206.439 (92,98%) foram negativas e 11.911 (5,36%) apresentaram algum tipo de atipias nucleares. Dentre as alterações epiteliais atípicas, 6.437(54,04%) foram de ASC-US e 210 (1,76%) de ASC-H; 3.264 (27,40%) de LSIL; 1.279 (10,74%) de HSIL; 131 (1,10%) de SCC; 552 (4,63%) por AGC-US e 23 (0,19%) de AGC-H; 7 (0,06%) de AIS e 8 (0,07%) de ADENOCA. Quanto à ocorrência e distribuição dos diagnósticos de lesões intraepiteliais escamosas e glandulares, de acordo com a faixa etária em intervalos de 5 anos, foi observada maior frequência de diagnóstico de LSIL entre as mulheres mais jovens (15-25 anos)e os diagnósticos de ASC-US, ASC-H, AGC-US, HSIL, SCC e ADENOCA nas mulheres >50 anos de idade. As alterações glandulares, como AGC-H e AIS, ocorreram em mulheres na faixa etária entre 30-34 e 45-49 anos. Foram detectados dois (0,16%) casos de HSIL em pacientes 14 anos e em 51 (3,99%) pacientes na faixa entre 15-19 anos. Os dados da presente avaliação enfatiza a importância de campanhas orientativas, rastreamento e seguimento das pacientes para garantir