RESUMO
OBJECTIVE: To determine the incremental costs and effects of different HPV testing strategies, when compared to Papanicolau cytology (Pap), for cervical cancer screening in Mexico. METHODS: A cost-effectiveness analysis (CEA) examined the specific costs and health outcomes associated with (1) no screening; (2) only the Pap test; (3) only self-administered HPV; (4) only clinician administered HPV; and (5) clinician administered HPV plus the Pap test. The costs of self- and clinician-HPV testing, as well as with the Pap test, were identified and quantified. Costs were reported in 2008 US dollars. The health outcome associated with these screening strategies was defined as the number of high-grade cervical intraepithelial neoplasia or cervical cancer cases detected. This CEA was performed using the perspective of the Mexican Institute of Social Security (IMSS) in Morelos, Mexico. RESULTS: Screening women between the ages of 30-80 for cervical cancer using clinical-HPV testing or the combination of clinical-HPV testing, and the Pap is always more cost-effective than using the Pap test alone. CONCLUSIONS: This CEA indicates that HPV testing could be a cost-effective screening alternative for a large health delivery organization such as IMSS. These results may help policy-makers implement HPV testing as part of the IMSS cervical cancer screening program.
Assuntos
Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/métodos , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Displasia do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Técnicas Citológicas/economia , Técnicas Citológicas/métodos , Feminino , Humanos , México , Pessoa de Meia-Idade , Papillomaviridae/fisiologia , Infecções por Papillomavirus/complicações , Neoplasias do Colo do Útero/etiologia , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal/métodos , Adulto Jovem , Displasia do Colo do Útero/etiologia , Displasia do Colo do Útero/virologiaRESUMO
OBJECTIVE: To evaluate the performance of the conventional Pap test and liquid-based cytology (LBC) in an ongoing multicenter trial testing optional screening tools (cytology, screening colposcopy, visual inspection with acetic acid, visual inspection with Lugol's Iodine, cervicography and Hybrid Capture II [HCII] (Digene Brazil, São Paulo, Brazil) conventional and self-sampling), for cervical cancer in Brazil and Argentina. STUDY DESIGN: A cohort of 12,107 women attending four clinics (Campinas, São Paulo, Porto Alegre, Buenos Aires) were randomized into the 8 diagnostic arms. Women testing positive with any of the tests were referred for colposcopy, and cervical biopsies were used as the gold standard to assess performance characteristics of the diagnostic tests. Conventional Pap smears were sampled by all clinics (n = 10,240), and LBC (Autocyte PREP, [TriPath Imaging, Burlington, North Carolina, U.S.A.], n=320, and DNA-Citoliq [Digene Brazil], n =1,346) was performed by 1 of the clinics. RESULTS: Conventional Pap smears showed no squamous intraepithelial lesions (normal) in 8,946 (87.4%) and LBC in 1,373 (82.4%). Using high grade squamous intraepithelial lesions (HSIL) as the cutoff, Pap smears predicted high grade (cervical intraepithelial neoplasia [CIN] 3) with OR 63.0 (95% CI, 36.90-107.70), standard error (SE) 59%, SP 97.8%, positive predictive value (PPV) 68.1% and negative predictive value (NPV) 96.7%. The same figures for Autocyte PREP were: OR 9.0 (95% CI, 2.43-33.24), sensitivity (SE) 33.3%, specificity (SP) 100%, PPV 100% and negative PV (NPV) 88.8%. DNA-Citoliq detected CIN 3 as follows: OR 11.8 (95% CI 2.60-53.26), SE 40.0%, SP 94.6%, PPV 40.0% and NPV 94.6%. Lowering the cutoff to low grade squamous intraepithelial lesions increased SE and NPV but compromised SP and PPV. The detection rates for high grade lesions after an atypical squamous cells of undetermined significance diagnosis were similar with the 3 techniques. In our settings, the 3 methods of cervical cytology were slightly different in performance. The conventional Pap smear had the highest SE, while Autocyte PREP had 100% SP and PPV in detecting CIN3 with the HSIL cutoff. All 3 tests had lower SE but higher SP as compared to HCII.
Assuntos
Carcinoma/diagnóstico , Técnicas Citológicas/estatística & dados numéricos , Técnicas Citológicas/tendências , Teste de Papanicolaou , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal/estatística & dados numéricos , Esfregaço Vaginal/tendências , Adulto , Argentina/epidemiologia , Brasil/epidemiologia , Carcinoma/epidemiologia , Carcinoma/prevenção & controle , Colo do Útero/patologia , Estudos de Coortes , Técnicas Citológicas/economia , Diagnóstico Diferencial , Erros de Diagnóstico , Células Epiteliais , Feminino , Humanos , América Latina/epidemiologia , Programas de Rastreamento , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal/economiaRESUMO
OBJECTIVE: To describe the cotton block method, an easy, inexpensive, 1-step method of obtaining a cell block after fine needle aspiration biopsy. STUDY DESIGN: Before connection to a 10-mL syringe, the plastic hub of a 22-23-gauge needle is filled with the 3-4-mm, woolly tip of a cotton bud. Aspiration is performed as described elsewhere. After smear preparation, the material remaining in the needle and the material retained in the cotton wool mesh are immediately fixed by aspiration ofa fixative fluid (70% alcoholic formaldehyde-acetic acid). After fixation, the cotton tip is removed and routinely processed for paraffin embedding, and the sections are stained by routine methods used in cytopathology. RESULTS: The results demonstrate that the amount and quality of material obtained in the cotton wool tip is similar to that in the traditional cell block obtained from the pellet after centrifugation of aspirated fluid. CONCLUSION: The method is easy to perform and cost effective and is a rapid way to prepare cell blocks of high quality, allowing special staining techniques and improving cytohistologic correlation.
Assuntos
Biópsia por Agulha Fina/instrumentação , Biópsia por Agulha Fina/métodos , Técnicas Citológicas , Técnicas Citológicas/economia , Desenho de Equipamento , HumanosRESUMO
OBJECTIVE: To develop a cost-effective, reliable and safe method of providing fungal control slides for routine use in pathology laboratories. STUDY DESIGN: A set of easily available, low-cost material was tested to obtain fungal colonies on substrate adequate for paraffin-embedded sections or smears. RESULTS: Such material as cheese is a simple, inexpensive and practical culture medium for silver-positive fungi. A batch of paraffin blocks can be prepared to maintain a stock of control material in the laboratory. CONCLUSION: It is useful to maintain fungal colonies to produce staining control specimens using small pieces of refrigerated cheese to easily produce silver-staining control specimens or smears embedded in paraffin, reducing the risk of accidental exposure to potentially infective pathogens in the laboratory. This method might also be a good alternative for conserving routine surgical specimens, considering the currently decreasing numbers of necropsy and large specimens, particularly from immunosuppressed and infected patients.
Assuntos
Corantes , Técnicas Citológicas/métodos , Fungos/citologia , Micoses/patologia , Patologia/métodos , Coloração e Rotulagem/métodos , Técnicas de Cultura de Células/economia , Técnicas de Cultura de Células/métodos , Queijo/microbiologia , Meios de Cultura , Técnicas Citológicas/economia , Fungos/metabolismo , Humanos , Patologia/economia , Coloração pela Prata/economia , Coloração e Rotulagem/economiaRESUMO
BACKGROUND AND STUDY AIMS: The increase in infectious diseases of the gastrointestinal tract related to immunosuppression is becoming an important topic for the endoscopist. To improve the diagnostic efficacy of tissue acquisition while at the same time restricting costs, we have developed a new device for obtaining material from the upper gastrointestinal tract that can also be used in the diagnosis of neoplastic disease. PATIENTS AND METHODS: A total of 90 patients were examined and assigned to two groups according to indications. Group A consisted of 53 symptomatic patients with positive human immunodeficiency virus (HIV) serology with a suspicion of gastrointestinal infection. Group B included 37 patients in whom there was an endoscopic suspicion of neoplasia in the upper gastrointestinal tract. Cell fragments for cytological study were obtained using a device introduced through the endoscopic instrumentation channel (abrasive cytology). Different staining methods were used to isolate bacteria or diagnose tumors from cell fragments. The findings were compared with those obtained from conventional bioptic histology. RESULTS: Potentially responsible pathogens were isolated in 48 of the 53 patients in Group A, while bioptic histology provided a diagnosis in only 32 patients. In the 37 patients in group B, the cytological diagnosis matched the histological results. The costs of this new technique are similar to those for conventional cytological staining, and the time from sampling to obtaining a final diagnosis is less than one hour. CONCLUSIONS: This new device provides a fast and low-cost method of isolating pathogens and obtaining cell fragments from the gastrointestinal mucosa during routine upper gastrointestinal endoscopy.