The relation between the detection of clue cells in cervical smears of women with CIN and the expression of COX-2 in these lesions were determined. Samples from 228 women, treated due to CIN and who underwent cervical conization, were obtained. Hybrid Capture II and Pap smear samples were collected immediately before performing conization. Pathological diagnoses were 11 (5%) normal cervix, 35 (15%) CIN1, 31 (14%) CIN2, and 151 (66%) CIN3. COX-2 immunoreactivity grading on the pathological specimens was based on the German ImmunoReactive score. In cervical smears, 20 fields (40x) were examined, each of them with a minimum count of 10 epithelial cells. When 20% or more of clue cells were detected the sample was considered positive for clue cells. The prevalence of clue cells was similar across histological strata (P = 0.42). Although the expression of COX-2 did not differ in lesions with varying severities (P = 0.24), there was a negative association between the expression of COX-2 and the presence of clue cells in Pap smear (OR = 0.4; 95% CI = 0.2-0.9): only 12% of women with moderate and strong expression of COX-2 had clue cells in their smears, contrasted to 22% of those with negative and weak expression of COX-2. HPV infection was associated in a borderline manner to the expression of COX-2 (P = 0.04; OR = 2.3 95% CI = 1.0-5.4). The reduced expression of COX-2 in CIN specimens may suggest that clue cells interfere with the inflammatory component of the carcinogenic process that lead to CIN.
Comparação entre a colpocitologia oncológica de encaminhamento e a da gravidade das lesões cervicais intra-epiteliais Oncologic colpocytology collected in the public health and reference services in the diagnostic of the severity of intraepithelial cervical lesion
Cervical cancer screening remains a challenge in developing countries due to a complex array of problems. This paper aimed to describe the experience with organization of cervical cancer screening in three districts of Campinas and the surrounding region in São Paulo State, Brazil, and to report the resulting data. The program was organized in a pyramid format, and the health care hierarchy was defined according to the complexity and total number of medical procedures. Screening has been extended currently to 88 municipalities, of which 51 are equipped with colposcopy and eight have facilities for treating advanced cervical cancer. The standardized incidence rate for cervical cancer in Campinas was 14.2/100,000 women per year in 1993-1995, and the standardized mortality rate per district ranged from 2.7 to 3.0 per 100,000 women in 1997-1998. This project has clearly shown that hierarchical and decentralized organization of health procedures is a necessary condition for achieving the goals of an effective cervical cancer screening program.
Resultados: os percentuais de exames alterados dos grupos 2 (2,6%) e 3 (2,4%), incluindo todas as lesões escamosas e glandulares, foram significativamente maiores que no grupo 1 (2%). Os percentuais de diagnóstico da lesão intra-epitelial escamosa de baixo grau (LIE-BG) não foram estatisticamente diferentes entre os três grupos (1,27; 1,25 e 1,07%). Por outro lado, os percentuais de diagnóstico da lesão intra-epitelial escamosa de alto grau (LIE-AG) foram significativamente maiores nos grupos 2 (0,81%) e 3 (0,77%) do que no grupo 1 (0,54%
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