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.
RESUMO Objetivo: avaliar a presença do DNA do papilomavírus humano (HPV) de alto risco oncológico antes e quatro meses após excisão da zona de transformação com alça diatérmica em mulheres com neoplasia intra-epitelial cervical (NIC (OR = 4,8; IC 95% = 1,(7)(8)(9)(10)(11)(12)(13)7), porém não se relacionou com doença residual ou recidiva histológica (OR = 6,0; IC 95% = 0,3
IntroduçãoA excisão da zona de transformação com alça diatérmica é hoje uma das técnicas cirúrgicas mais utilizadas para o diagnóstico e tratamento da neoplasia intra-epitelial cervical (NIC). Existe correlação entre o comprometimento das margens da peça cirúrgica e a freqüência de doença residual e de recidiva. Porém, se 30% das mulheres com margens comprometidas apresentam doença residual no colo restante, 8% daquelas com margens livres, também apresentem doença residual ou recidiva 1-3 . Assim, atualmente, se tem optado pelo seguimento das mulheres submetidas à conização por NIC independentemente do comprometimento das margens do cone, com a coleta de colpocitologia oncológica (CO) e realização de colposcopia. Porém, um grande impulso vem sendo dado às pesquisas que possam identificar um novo marcador de recidiva após a conização [4][5][6] .Está bem estabelecido o papel do papiloma-
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