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CC BY-NC-ND 4.0 · Rev Bras Ginecol Obstet 2018; 40(07): 410-416
DOI: 10.1055/s-0038-1666995
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Performance of Conventional Cytology and Colposcopy for the Diagnosis of Cervical Squamous and Glandular Neoplasias

Desempenho da citologia convencional e da colposcopia para o diagnóstico de neoplasias cervicais escamosas e glandulares
Giselle Fachetti-Machado
1   Health Sciences Postgraduate Program, Universidade Federal de Goiás, Goiânia, GO, Brazil
,
Rosane Ribeiro Figueiredo-Alves
1   Health Sciences Postgraduate Program, Universidade Federal de Goiás, Goiânia, GO, Brazil
,
Marise Amaral Rebouças Moreira
1   Health Sciences Postgraduate Program, Universidade Federal de Goiás, Goiânia, GO, Brazil
› Author Affiliations
Further Information

Publication History

03 February 2018

17 May 2018

Publication Date:
11 July 2018 (online)

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Abstract

Objective To estimate the cytological and colposcopic performances for the diagnosis of cervical neoplasias.

Methods Cross-sectional retrospective study with data from patients' charts. The participants underwent colposcopy, guided biopsies, and excision when needed. The cytological and colposcopic categorization followed the Bethesda System and the international colposcopic terminologies. The cytology and colposcopy performances were evaluated by sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) analyses with 95% confidence interval (95% CI).

Results From 1,571 participants, a total of 1,154 (73.4%) were diagnosed with cervical squamous intraepithelial neoplasia grade 2 or worse (CIN 2+), 114 (7.2%) with adenocarcinoma in situ or worse (AIS+), 615 (39.2%) presented atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion or worse (ASC-H+) cytology, and 934 (59.4%) presented major or suspicious for invasion colposcopic abnormalities. The SE, SP, PPV, and NPV of ASC-H+ for diagnoses of CIN 2+ and AIS+ were, respectively: 44% (95% CI: 41–47) and 72% (95% CI: 67–76), 79% (95% CI: 77–81) and 79% (95% CI: 75–83), 88% (95% CI: 87–90) and 55% (95% CI: 50–60), and 28% (95% CI: 26–31) and 88% (95% CI: 85–91). The SE, SP, PPV, and NPV of major or suspicious for invasion colposcopic abnormalities for diagnoses of CIN 2+ and AIS+ were, respectively: 62% (95% CI: 60–65) and 86% (95% CI: 83–89), 59% (95% CI: 57–62) and 59% (95% CI: 55–64), 85% (95% CI: 83–87) and 44% (95% CI: 40–49), and 29% (95% CI: 27–32) and 92% (95% CI: 89–94).

Conclusion The SE analyses results of ASC-H+ and major or suspicious for invasion colposcopic abnormalities were higher for diagnoses of glandular neoplasias. These results confirm the role of cytology in identifying women at risk who will have their final diagnoses settled by colposcopy and histology.

Resumo

Objetivo Estimar o desempenho da citologia e colposcopia no diagnóstico das neoplasias cervicais.

Métodos Estudo retrospectivo de corte transversal com dados coletados em prontuários. Foram incluídas participantes que foram submetidas a colposcopia, biópsia e excisão quando necessário. A categorização da citologia e da colposcopia seguiram a terminologia de Bethesda e a classificação colposcópica internacional. Os desempenhos da citologia e colposcopia foram avaliados por análises de sensibilidade (S), especificidade (E), valor preditivo positivo (VPP) e valor preditivo negativo (VPN), com intervalos de confiança de 95% (IC 95%).

Resultados Das 1.571 participantes, um total de 1.154 (73,4%) foram diagnosticadas com neoplasia intraepitelial escamosa cervical de grau 2 ou mais grave (NIC 2+), 114 (7,2%) com adenocarcinoma in situ ou mais grave (AIS+), 615 (39,2%) apresentaram células escamosas atípicas de significado indeterminado, quando não se pode excluir lesão intraepitelial de alto grau ou mais grave (ASC-H+) e 934 (59,4%) tiveram achados colposcópicos maiores ou suspeitos de invasão. Os valores de S, E, VPP e VPN das ASC-H+ para o diagnóstico de NIC 2+ e AIS+ foram, respectivamente: 44% (IC 95%: 41–47) e 72% (IC 95%: 67–76), 79% (IC 95%: 77–81) e 79% (IC 95%: 75–83), 88% (IC 95%: 87–90) e 55% (IC 95%: 50–60) e 28% (IC 95%: 26–31) e 88% (IC 95%: 85–91). Os valores de S, E, VPP e VPN dos achados colposcópicos maiores ou suspeitos de invasão para o diagnóstico de NIC 2+ e AIS+ foram, respectivamente: 62% (IC 95%: 60–65) e 86% (IC 95%: 83–89), 59% (IC 95%: 57–62) e 59% (IC 95%: 55–64), 85% (IC 95%: 83–87) e 44% (IC 95%: 40–49) e 29% (IC 95%: 27–32) e 92% (IC 95%: 89–94).

Conclusão Os resultados das análises de S de ASC-H+ e achados colposcópicos maiores ou suspeitos de invasão foram mais elevados para o diagnóstico das neoplasias glandulares. Esses resultados confirmam o papel da citologia na identificação de mulheres em risco que terão seus diagnósticos definidos por colposcopia e histologia.

Keywords

uterine cervical neoplasms - cervical intraepithelial neoplasia - squamous intraepithelial lesions of the cervix - adenocarcinoma in situ - papanicolaou test - colposcopy - sensitivity and specificity

Palavras-chave

neoplasias do colo do útero - neoplasia intraepitelial cervical - lesões intraepiteliais escamosas cervicais - adenocarcinoma in situ - exame colpocitológico - colposcopia - sensibilidade e especificidade

Contributions

Fachetti-Machado G., Figueiredo-Alves R. R. and Moreira M. A. R. contributed with the project and interpretation of data, writing of the article, critical review of the intellectual content and final approval of the version to be published.


 

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