Validade da citologia cervicovaginal na detecção de lesões pré-neoplásicas e neoplásicas de colo de útero
Carregando...
Data
2002-07-01
Autores
Pinho, Adriana de Araujo
Mattos, Maria Cristina F. Iwama de [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Sociedade Brasileira de Patologia ClínicaSociedade Brasileira de PatologiaSociedade Brasileira de Citopatologia
Resumo
Introdução: O exame colpocitológico ou teste de Papanicolaou permite o diagnóstico precoce do câncer de colo do útero. O êxito no rastreamento desta doença dependerá, além de outros fatores, da acuidade diagnóstica do exame colpocitológico. Objetivos: Avaliar a acurácia diagnóstica da citologia cervicovaginal na detecção de lesões cervicais através da comparação citoistopatológica. Material e métodos: Avaliou-se o grau de concordância entre os exames citológico e histopatológico de 373 pacientes atendidas em um hospital universitário no período de 1990 a 1997 e foram calculados os indicadores: sensibilidade, especificidade, valores preditivos positivos e negativos e as taxas de falsos positivos e falsos negativos do exame. Resultados: A taxa bruta de concordância citoistopatológica foi de 65,1%. A sensibilidade do exame foi alta (96,0%), no entanto sua especificidade foi baixa (51,5%), significando a inclusão de muitos resultados falsos positivos. A taxa de falsos positivos foi de 48,4%, enquanto a de falsos negativos foi de 4%. Discussão: Apesar de a sensibilidade do teste ser alta, sua especificidade é baixa, significando que muitas mulheres seriam falsamente diagnosticadas como doentes, levando a um número elevado de resultados falsos positivos e custos desnecessários, além do potencial caráter iatrogênico que esta ação poderia assumir. No entanto, um exame altamente sensível é o teste de escolha para programas de rastreamento de câncer cervical na população feminina. Conclusões: Para garantir a acuidade diagnóstica do teste de Papanicolaou são essenciais atividades de controle de qualidade nos laboratórios, tanto do procedimento colpocitológico quanto do histopatológico, permitindo, assim, o êxito na detecção precoce e no tratamento das lesões cervicais.
Background: The cervicovaginal cytology or Papanicolaou (Pap) test allows the early diagnosis of cervical cancer. Success of cervical cancer screening depends, among other factors, on the diagnostic accuracy of Pap test. Objectives: To evaluate the diagnostic accuracy of cervicovaginal cytology in the detection of cervical lesions through cito-histopathological correlation. Methods: We evaluated the degree of correlation between the cytological results and cervical biopsies from 373 patients assisted at a university hospital in the period from 1990 through 1997. The indicators: sensitivity, specificity, positive and negative predictive values and false positive and false negative rates for cervicovaginal cytology diagnosis were calculated. Results: The crude rate of cito-histopathological correlation was 65.1%. The sensitivity of the Pap test was high (96%); its specificity, however, was low (51.5%), resulting in the inclusion of many false positive results. The rate of false positive results was 48.4%, whereas the rate of false negative results was 4%. Discussion: Despite the higher sensitivity of the test, its specificity is low, meaning that a lot of women would be falsely diagnosed as ill, resulting in a high number of false positive results and unnecessary costs, in addition to the potential iatrogenic character of this preventive practice. However, a highly sensitive test is the test of choice for the screening of cervical cancer among the female population. Conclusions: In order to guarantee the diagnostic accuracy of the Pap test, it is imperative to establish quality control activities for colpocytological and histopathological procedures, thus allowing success in early detection and treatment of cervical lesions.
Background: The cervicovaginal cytology or Papanicolaou (Pap) test allows the early diagnosis of cervical cancer. Success of cervical cancer screening depends, among other factors, on the diagnostic accuracy of Pap test. Objectives: To evaluate the diagnostic accuracy of cervicovaginal cytology in the detection of cervical lesions through cito-histopathological correlation. Methods: We evaluated the degree of correlation between the cytological results and cervical biopsies from 373 patients assisted at a university hospital in the period from 1990 through 1997. The indicators: sensitivity, specificity, positive and negative predictive values and false positive and false negative rates for cervicovaginal cytology diagnosis were calculated. Results: The crude rate of cito-histopathological correlation was 65.1%. The sensitivity of the Pap test was high (96%); its specificity, however, was low (51.5%), resulting in the inclusion of many false positive results. The rate of false positive results was 48.4%, whereas the rate of false negative results was 4%. Discussion: Despite the higher sensitivity of the test, its specificity is low, meaning that a lot of women would be falsely diagnosed as ill, resulting in a high number of false positive results and unnecessary costs, in addition to the potential iatrogenic character of this preventive practice. However, a highly sensitive test is the test of choice for the screening of cervical cancer among the female population. Conclusions: In order to guarantee the diagnostic accuracy of the Pap test, it is imperative to establish quality control activities for colpocytological and histopathological procedures, thus allowing success in early detection and treatment of cervical lesions.
Descrição
Palavras-chave
Câncer cervical, Teste de Papanicolaou, Validade, Diagnóstico, Sensibilidade, Especificidade, Cervical cancer, Papanicolaou test, Validity, Diagnosis, Sensitivity, Specificity
Como citar
Jornal Brasileiro de Patologia e Medicina Laboratorial. Sociedade Brasileira de Patologia ClínicaSociedade Brasileira de PatologiaSociedade Brasileira de Citopatologia, v. 38, n. 3, p. 225-231, 2002.