Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(5):222-228
DOI 10.1590/SO100-720320150005183
To estimate the prevalence of bacterial vaginosis (BV), candidiasis and
trichomoniasis and compare the findings of physical examination of the vaginal
secretion with the microbiological diagnosis obtained by cytology study of a
vaginal smear using the Papanicolaou method.
A cross-sectional study of 302 women aged 20 to 87 years, interviewed and
submitted to a gynecology test for the evaluation of vaginal secretion and
collection of a cytology smear, from June 2012 to May 2013. Sensitivity analyses
were carried out and specificity, positive predictive value (PPV) and negative
predictive value (NPV) with their respective 95%CI were determined to assess the
accuracy of the characteristics of vaginal secretion in relation to the
microbiological diagnosis of the cytology smear . The kappa index (k) was used to
assess the degree of agreement between the clinical features of vaginal secretion
and the microbiological findings obtained by cytology.
The prevalence of BV, candidiasis and trichomoniasis was 25.5, 9.3 and 2.0%,
respectively. The sensitivity, specificity, PPV and NPV of the clinical
characteristics of vaginal secretion for the cytological diagnosis of BV were 74,
78.6, 54.3 and 89.9%, respectively. The sensitivity, specificity, PPV and the NPV
of the clinical characteristics of vaginal secretion for the cytological diagnosis
of candidiasis were 46.4, 86.2, 25.5 and 94%, respectively. The correlation
between the clinical evaluation of vaginal secretion and the microbiological
diagnosis of BV, candidiasis and trichomoniasis, assessed by the kappa index, was
0.47, 0.23 and 0.28, respectively.
The most common cause of abnormal vaginal secretion was BV. The clinical
evaluation of vaginal secretion presented amoderate to weak agreement with the
microbiological diagnosis, indicating the need for complementary investigation of
the clinical findings of abnormal vaginal secretion.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(1):40-45
DOI 10.1590/S0100-72032014000100009
To analyze the cytological findings of women with cervical adenocarcinoma, taking
into account the patient's history in the year prior to diagnosis and the
histopathological aspects of the lesions.
A retrospective comparative study was conducted using data from women with
cervical adenocarcinoma or squamous carcinoma detected between 2002 and 2008. The
cytological reports were synthesized according to the Bethesda System revised in
2001 and were compared to the histopathological findings of cervical
adenocarcinoma and squamous carcinoma. The distributions of cytological findings
were calculated, as well as the global agreement and chance-corrected agreement
using the Cohen's Kappa Coefficient. For this purpose, the cytological findings
were grouped according to the epithelial origin, forming the glandular cell and
squamous cell groups, with the histopathologically confirmed tumor types
(adenocarcinoma versus squamous carcinoma) being used as the gold
standard.
A total of 284 cases of cervical cancer were diagnosed during the study period.
The effectively studied cases were 27 and 54 patients with adenocarcinoma and
squamous carcinoma, respectively. The adenocarcinoma group represented 9.5% of the
total cases diagnosed, and 56.0% of the women in this group were younger than 50
years. Cervical cytology was collected on average 92 days before the cancer
diagnosis (range: 19 days to 310 days). In 41.6% of cases the cytological results
were consistent with glandular alterations such as adenocarcinoma cells or
atypical glandular cells. The global agreement and Cohen's Kappa Coefficient were
73.7 and 48.7%, suggesting substantial and moderate agreement, respectively.
In this population, the cytological smears had an important role in screening
women with adenocarcinoma, although some of them were referred to clarify the
clinical symptoms. The agreement between cytological and histopathological
findings was moderate.