Colpocytology Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 1999;21(7):401-405
DOI 10.1590/S0100-72031999000700006
Purpose: to investigate if the addition of a cotton "swab" to the Ayre spatula and its previous moistening with physiologic saline solution increase the obtention of endocervical cells in colpocytologic smears. Methods: a random and single-blind diagnostic study was performed, involving three techniques of collection (Ayre spatula, combination of Ayre-dry cotton swab spatula and combination of Ayre-moist cotton swab spatula). A total of 307 smears prepared by Medicine students and residents of Gynecology and Obstetrics were evaluated. Results: there was no significant increase in the number of endocervical cells (columnar and/or metaplastic), obtained with the addition of dry swab (p = 0.2) or with the addition of a moistened swab (p = 0.8). Conclusions: the author concluded that mainly when the collections were performed by trainee professionals and in the absence of other more effective endocervical collecting device, it is more economical to use only the Ayre spatula to prepare the smear.
Summary
Rev Bras Ginecol Obstet. 1999;21(7):401-405
DOI 10.1590/S0100-72031999000700006
Purpose: to investigate if the addition of a cotton "swab" to the Ayre spatula and its previous moistening with physiologic saline solution increase the obtention of endocervical cells in colpocytologic smears. Methods: a random and single-blind diagnostic study was performed, involving three techniques of collection (Ayre spatula, combination of Ayre-dry cotton swab spatula and combination of Ayre-moist cotton swab spatula). A total of 307 smears prepared by Medicine students and residents of Gynecology and Obstetrics were evaluated. Results: there was no significant increase in the number of endocervical cells (columnar and/or metaplastic), obtained with the addition of dry swab (p = 0.2) or with the addition of a moistened swab (p = 0.8). Conclusions: the author concluded that mainly when the collections were performed by trainee professionals and in the absence of other more effective endocervical collecting device, it is more economical to use only the Ayre spatula to prepare the smear.
Summary
Rev Bras Ginecol Obstet. 1999;21(6):327-331
DOI 10.1590/S0100-72031999000600005
Purpose: the authors modified the original Ayre spatula aiming at optimizing endocervical collection. The study verified if the capacity of the modified spatula in collecting endocervical cells is similar to that obtained by the combination brush-Ayre spatula and better than the Ayre spatula alone. Methods: a diagnostic and single-blind simple study was performed. The patients were randomly assigned to one of three collection groups (Ayre spatula, combination of brush-Ayre spatula and modified spatula). After excluding data of 25 patients, 276 smears were evaluated with attention to the presence of squamous, metaplastic, and columnar endocervical cells and their combination. In order to compare methods, the chi² test with corrected Yates values and the exact Fisher test were used. Results: the combination brush-Ayre spatula presented the best performance in the production of columnar endocervical cells. When compared to the combination of brush-Ayre spatula, the modified spatula produced less bleeding in the smears (chi² = 7.98; p = 0.004) and it was not statistically inferior in obtaining metaplastic cells (chi² = 2.97; p = 0.08). When compared to the Ayre spatula, it was statistically superior in obtaining columnar endocervical cells (chi² = 21.37; p = 0.000004) and presented a greater percentage of smears presenting squamous cells accompanied by metaplastic and/or columnar endocervical cells (chi² = 10.97; p = 0.0009). Conclusions: it was concluded that the modified spatula improved the quality of the sample obtained with the Ayre spatula alone, being able to be used in populations where the use of the brush was impossible.
Summary
Rev Bras Ginecol Obstet. 1999;21(6):327-331
DOI 10.1590/S0100-72031999000600005
Purpose: the authors modified the original Ayre spatula aiming at optimizing endocervical collection. The study verified if the capacity of the modified spatula in collecting endocervical cells is similar to that obtained by the combination brush-Ayre spatula and better than the Ayre spatula alone. Methods: a diagnostic and single-blind simple study was performed. The patients were randomly assigned to one of three collection groups (Ayre spatula, combination of brush-Ayre spatula and modified spatula). After excluding data of 25 patients, 276 smears were evaluated with attention to the presence of squamous, metaplastic, and columnar endocervical cells and their combination. In order to compare methods, the chi² test with corrected Yates values and the exact Fisher test were used. Results: the combination brush-Ayre spatula presented the best performance in the production of columnar endocervical cells. When compared to the combination of brush-Ayre spatula, the modified spatula produced less bleeding in the smears (chi² = 7.98; p = 0.004) and it was not statistically inferior in obtaining metaplastic cells (chi² = 2.97; p = 0.08). When compared to the Ayre spatula, it was statistically superior in obtaining columnar endocervical cells (chi² = 21.37; p = 0.000004) and presented a greater percentage of smears presenting squamous cells accompanied by metaplastic and/or columnar endocervical cells (chi² = 10.97; p = 0.0009). Conclusions: it was concluded that the modified spatula improved the quality of the sample obtained with the Ayre spatula alone, being able to be used in populations where the use of the brush was impossible.
Summary
Rev Bras Ginecol Obstet. 2005;27(2):51-57
DOI 10.1590/S0100-72032005000200002
PURPOSE: to estimate the validity of visual inspection of cervical intraepithelial neoplasia (CIN) and HPV-induced lesion screening, after acetic acid application (VIA), and to compare its performance with that of colpocytology and colposcopy. METHODS: a diagnostic test validation study involving 893 women aged 18 to 65 years, simultaneously screened with colpocytology, VIA and colposcopy was carried out at a public health unit in Recife, PE. VIA was performed by applying 5% acetic acid onto the cervix and observing it with the help of a clinical spotlight. The finding of any aceto-white lesion on the cervix was considered positive. The gold standard was the histopathology of cervical biopsy, carried out whenever any of the three test results was abnormal. Validity indicators were estimated for each test, within 95% confidence intervals. The analysis of agreement between test results was done by the kappa coefficient. RESULTS: of 303 women submitted to biopsy, the histopathological study was abnormal in 24. Among this total, VIA was positive in 22, yielding an estimated 91.7% sensibility, 68.9% specificity, and 7.5% positive predictive value and 99.7% negative predictive value. Comparing 95% confidence intervals, VIA was more sensitive than colpocytology, despite a lower specificity and positive predictive value. There was poor agreement between VIA and colpocytology (k=0.02) and excellent agreement with colposcopy (k=0.93). CONCLUSION: VIA was much more sensitive than colpocytology in the screening of CIN and HPV-induced lesions and presented a performance similar to colposcopy. Its low specificity determined a high number of false-positive results.
Summary
Rev Bras Ginecol Obstet. 2005;27(2):51-57
DOI 10.1590/S0100-72032005000200002
PURPOSE: to estimate the validity of visual inspection of cervical intraepithelial neoplasia (CIN) and HPV-induced lesion screening, after acetic acid application (VIA), and to compare its performance with that of colpocytology and colposcopy. METHODS: a diagnostic test validation study involving 893 women aged 18 to 65 years, simultaneously screened with colpocytology, VIA and colposcopy was carried out at a public health unit in Recife, PE. VIA was performed by applying 5% acetic acid onto the cervix and observing it with the help of a clinical spotlight. The finding of any aceto-white lesion on the cervix was considered positive. The gold standard was the histopathology of cervical biopsy, carried out whenever any of the three test results was abnormal. Validity indicators were estimated for each test, within 95% confidence intervals. The analysis of agreement between test results was done by the kappa coefficient. RESULTS: of 303 women submitted to biopsy, the histopathological study was abnormal in 24. Among this total, VIA was positive in 22, yielding an estimated 91.7% sensibility, 68.9% specificity, and 7.5% positive predictive value and 99.7% negative predictive value. Comparing 95% confidence intervals, VIA was more sensitive than colpocytology, despite a lower specificity and positive predictive value. There was poor agreement between VIA and colpocytology (k=0.02) and excellent agreement with colposcopy (k=0.93). CONCLUSION: VIA was much more sensitive than colpocytology in the screening of CIN and HPV-induced lesions and presented a performance similar to colposcopy. Its low specificity determined a high number of false-positive results.
Summary
Rev Bras Ginecol Obstet. 2003;25(3):193-200
DOI 10.1590/S0100-72032003000300008
PURPOSE: to evaluate the diagnostic procedures used in women with Pap smear result of atypical glandular cells. PATIENTS AND METHODS: a prospective study with 159 women with atypical glandular cells was carried out between January and December 2000. All women were submitted to a new colpocytology and to colposcopy. Directed biopsy was performed in 50 cases, endocervical curettage in 21 and conization in 75. The performance of the diagnostic procedures was described by estimating the sensitivity, specificity, predictive values and likelihood ratio, considering histological results as gold standard. RESULTS: the histological evaluation showed 51 intraepithelial squamous lesions, 29 low grade and 22 high grade. Five women presented in situ adenocarcinoma and six patients presented invasive neoplasias. Colpocytology alone showed sensitivity and specificity of 88.5 and 39%, respectively, and colposcopy alone, 74 and 42%. The association of colpocytology with colposcopy increased the sensitivity to 98.4%, with a significantly lower specificity of 10%. Endocervical curettage showed low sensitivity (25%). CONCLUSION: the presence of atypical glandular cells on colpocytology was associated with preinvasive and invasive cervical lesions in 62.2% of the cases with histological evaluation. Repeating colpocytology and performing colposcopy allowed to select the women who needed histological evaluation. Conization was an adequate procedure when examination continued to show morphologic alterations.
Summary
Rev Bras Ginecol Obstet. 2003;25(3):193-200
DOI 10.1590/S0100-72032003000300008
PURPOSE: to evaluate the diagnostic procedures used in women with Pap smear result of atypical glandular cells. PATIENTS AND METHODS: a prospective study with 159 women with atypical glandular cells was carried out between January and December 2000. All women were submitted to a new colpocytology and to colposcopy. Directed biopsy was performed in 50 cases, endocervical curettage in 21 and conization in 75. The performance of the diagnostic procedures was described by estimating the sensitivity, specificity, predictive values and likelihood ratio, considering histological results as gold standard. RESULTS: the histological evaluation showed 51 intraepithelial squamous lesions, 29 low grade and 22 high grade. Five women presented in situ adenocarcinoma and six patients presented invasive neoplasias. Colpocytology alone showed sensitivity and specificity of 88.5 and 39%, respectively, and colposcopy alone, 74 and 42%. The association of colpocytology with colposcopy increased the sensitivity to 98.4%, with a significantly lower specificity of 10%. Endocervical curettage showed low sensitivity (25%). CONCLUSION: the presence of atypical glandular cells on colpocytology was associated with preinvasive and invasive cervical lesions in 62.2% of the cases with histological evaluation. Repeating colpocytology and performing colposcopy allowed to select the women who needed histological evaluation. Conization was an adequate procedure when examination continued to show morphologic alterations.
Summary
Rev Bras Ginecol Obstet. 2001;23(6):349-354
DOI 10.1590/S0100-72032001000600002
Purpose: to evaluate the histopathologic results of cone specimens of patients undergoing loop electrosurgical excision procedure (LEEP) and their relationship with the localization of the lesion. Methods: in a retrospective study, 134 clinical reports of patients with abnormal findings of cervical cytology and/or biopsy undergoing LEEP were reviewed. The colposcopic findings were divided into three groups according to the localization of the lesion. Group I (n = 36): patients with ectocervical lesions and fully visible squamocolumnar junction; Group II (n = 50): patients with lesions at the ectocervix and endocervix, and Group III (n = 48): patients with unsatisfactory colposcopy. Results: the mean age in Group I was 33 years and there were 8.3% positive margins. In Group II the mean age was 39 years, with 36% positive margins. Group III had a mean age of 48 years and presented 29.2% positive margins. The percentage of residual disease was 4.2% in Group I, 31.6% in Group II and 35.5% in Group III. Conclusion: patients with lesions at the endocervical canal showed a higher rate of positive margins. Patients with high-grade cervical intraepithelial neoplasia at the endocervical canal and older than 40 years have a greater chance of showing positive margins and residual disease, therefore requiring stricter cytologic and colposcopic follow-up.
Summary
Rev Bras Ginecol Obstet. 2001;23(6):349-354
DOI 10.1590/S0100-72032001000600002
Purpose: to evaluate the histopathologic results of cone specimens of patients undergoing loop electrosurgical excision procedure (LEEP) and their relationship with the localization of the lesion. Methods: in a retrospective study, 134 clinical reports of patients with abnormal findings of cervical cytology and/or biopsy undergoing LEEP were reviewed. The colposcopic findings were divided into three groups according to the localization of the lesion. Group I (n = 36): patients with ectocervical lesions and fully visible squamocolumnar junction; Group II (n = 50): patients with lesions at the ectocervix and endocervix, and Group III (n = 48): patients with unsatisfactory colposcopy. Results: the mean age in Group I was 33 years and there were 8.3% positive margins. In Group II the mean age was 39 years, with 36% positive margins. Group III had a mean age of 48 years and presented 29.2% positive margins. The percentage of residual disease was 4.2% in Group I, 31.6% in Group II and 35.5% in Group III. Conclusion: patients with lesions at the endocervical canal showed a higher rate of positive margins. Patients with high-grade cervical intraepithelial neoplasia at the endocervical canal and older than 40 years have a greater chance of showing positive margins and residual disease, therefore requiring stricter cytologic and colposcopic follow-up.
Summary
Rev Bras Ginecol Obstet. 2002;24(3):187-192
DOI 10.1590/S0100-72032002000300007
Purpose: in order to maintain the gonadal function after oophorectomy, morphofunctional aspects of ovarian autotransplantation to the greater omentum and the best kind of implantation, intact or sliced, were investigated. Methods: forty cycling female Wistar rats were randomly divided into four groups: Group I (n = 5), control - laparotomy; Group II (n = 5), bilateral oophorectomy; Group III (n = 10), intact ovarian autotransplantation to the greater omentum; and Group IV (n = 10), sliced ovarian autotransplantation, both to the greater omentum. The estrous cycle was investigated in the third and sixth postoperative months and histological studies of the ovarian implants were carried out considering: degeneration, fibrosis, inflammatory reaction, angiogenesis, follicular cysts, follicular development and corpora lutea. Results: the animals of Group I preserved the cycling sequence. The rats of Group II remained in diestrus. In Group III, 11 rats remained in diestrus, three presented incomplete cycles and one showed normal cycle. In Group IV, three animals remained in diestrus, eight showed incomplete cycles and four showed normal cycles. The histology of the ovaries of Group III was normal in ten female rats; however, the ovaries of the other five animals presented degeneration. In Group IV, 14 female rats had ovaries with preserved morphological aspect, and signs of degeneration occurred in one. Conclusions: the ovarian autotransplantation to the greater omentum is viable and the sliced form presented better morphofunctional aspects than the intact implants.
Summary
Rev Bras Ginecol Obstet. 2002;24(3):187-192
DOI 10.1590/S0100-72032002000300007
Purpose: in order to maintain the gonadal function after oophorectomy, morphofunctional aspects of ovarian autotransplantation to the greater omentum and the best kind of implantation, intact or sliced, were investigated. Methods: forty cycling female Wistar rats were randomly divided into four groups: Group I (n = 5), control - laparotomy; Group II (n = 5), bilateral oophorectomy; Group III (n = 10), intact ovarian autotransplantation to the greater omentum; and Group IV (n = 10), sliced ovarian autotransplantation, both to the greater omentum. The estrous cycle was investigated in the third and sixth postoperative months and histological studies of the ovarian implants were carried out considering: degeneration, fibrosis, inflammatory reaction, angiogenesis, follicular cysts, follicular development and corpora lutea. Results: the animals of Group I preserved the cycling sequence. The rats of Group II remained in diestrus. In Group III, 11 rats remained in diestrus, three presented incomplete cycles and one showed normal cycle. In Group IV, three animals remained in diestrus, eight showed incomplete cycles and four showed normal cycles. The histology of the ovaries of Group III was normal in ten female rats; however, the ovaries of the other five animals presented degeneration. In Group IV, 14 female rats had ovaries with preserved morphological aspect, and signs of degeneration occurred in one. Conclusions: the ovarian autotransplantation to the greater omentum is viable and the sliced form presented better morphofunctional aspects than the intact implants.
