Follow-up of women with inadequate Pap smears: a prospective cohort study

Abstract

CONTEXT AND OBJECTIVE: Inadequate Pap smears do not provide satisfactory cell samples for evaluation, thus making it more difficult to detect cervical cytological abnormalities. The objective of this study was to determine the cytological and histological follow-up results from women with inadequate smear reports in primary healthcare centers in Santiago, Chile 2010-2011. DESIGN AND SETTING: Prospective cohort study at primary healthcare clinics in Santiago, Chile. METHODS:The population was taken from the "Cito-Expert" database of 2010. The data were then organized according to the cytological and histological follow-up results of 2,547 women with inadequate cervical cytological reports over the 12-month period. The samples were assigned to groups based on the cause of inadequacy (smears with endocervical cells alone; insufficient, hemorrhagic, inflammatory or poorly fixed samples; insufficient and hemorrhagic samples; or insufficient and inflammatory specimens). The data were analyzed using the "conditional probability tree diagram" and descriptive statistics. RESULT: Half of the women (n = 1,285) met the requirements of the Ministry of Health for repeating these inadequate smears, and 1,104 of these women had normal cytological results (85.9%). The detection rate for cervical lesions according to group ranged from 0% (smears with endocervical cells alone or insufficient and hemorrhagic specimens) to 4.1% (poor fixation). CONCLUSION:The large proportion of normal results justifies revision of the current clinical guidelines. The results showed that it is not necessary to repeat the Pap test early on, with the exception of inadequate hemorrhagic and inflammatory cytological results.RESUMO CONTEXTO E OBJETIVO: Esfregaços inadequados de Papanicolaou não fornecem amostra satisfatória de células para avaliação, ficando assim mais difícil detectar anomalias citológicas cervicais. O objetivo deste estudo foi determinar os resultados de seguimento citológico e histológico de mulheres com relatórios de esfregaços inadequados nas unidades básicas de saúde em Santiago, Chile, 2010. DESENHO E LOCAL: Estudo prospectivo de coorte em unidades básicas de saúde em Santiago, Chile. MÉTODOS: A população foi selecionada do banco de dados Cito-Expert em 2010. Na sequência, os dados foram organizados pelos resultados de seguimento citológico e histológico de 2.547 mulheres com relatórios inadequados de citologia cervical pelo período de 12 meses. As amostras foram atribuídas a grupos com base na causa de inadequação (esfregaços com células endocervicais; amostras insuficientes, inflamatórias, ou com má fixação, amostras insuficientes e hemorrágicas, ou espéci-mes insuficientes e inflamatórios). Os dados foram analisados com base no "conditional probability tree diagram" e estatísticas descritivas. RESULTADOS: Metade das mulheres (n = 1.285) preencheram os requisitos do Ministério da Saúde para repetir esses esfregaços; dessas mulheres, 1.104 tiveram resultados normais para citologia (85,9%). A detecção de lesões cervicais p...

Implementation of a real‐time reference and calibration grid platform for improved screening – mapping in Pap test slides

“…Despite the previous progress, there are still some critical technical and human factors that influence diagnostic reliability in Pap tests. Adequate quantity and quality of the specimens (specimen adequacy), optimal staining process, and screener's experience in diagnosis are important factors for securing a complete and reliable Pap test evaluation . Furthermore, cellularity, cell coating and spreading patterns on the slide seem to seriously affect the screening process.…”

“…Adequate quantity and quality of the specimens (specimen adequacy), optimal staining process, and screener's experience in diagnosis are important factors for securing a complete and reliable Pap test evaluation. 17,18 Furthermore, cellularity, cell coating and spreading patterns on the slide seem to seriously affect the screening process. Small to large empty spaces between cell aggregates and isolated, scattered cells affect the screener's observation under bright-field microscopes by decreasing the level of orientation on the entire slide.…”

Frequency of intraepithelial lesions in the follow-up of women with unsatisfactory cervicovaginal cytology

“…The 3-year follow-up of these patients was reviewed, 113 (72.4%) had cytology repeated and were categorized the 1 st year and ordered by frequency in 119 (76.3%) negative, 27 (17.4%) positive, 1 (0.6%) atypical squamous cells cannot exclude a high-grade lesion, Mexico "Dr. Eduardo Liceaga," in this study of 8212 cytologies performed during the period from 2013 to 2014, the unsatisfactory represented 7.9%, a percentage that is not less low than that reported in other series with a range of 0.8-11.7% 6,10,11,17 .…”

“…Inadequate cervicovaginal cytologies are presented in less than 2% annually in the General Hospital of abnormality, a considerably high percentage compared to that reported in the literature from 1.1 to 9.4% 6,17 . In the following 2 years of follow-up, 15.5% and 7.7%, respectively, of diagnoses with lesions were observed, of which 16.7% presented squamous abnormalities.…”

Nuevas estrategias de prevención y control de cáncer de cuello uterino en Chile

“…2 Por otro lado, actualmente un número significativo de mujeres con lesiones ASCUS o con Pap insatisfactorio (18.6%) no regresa a repetirse el examen o no acepta la derivación. 32 Esta pérdida disminuirá cuando no sea necesario citar a las mujeres para repetirse un examen, sino que sólo se citen cuando se requiera un proceso diagnóstico o de seguimiento. La nueva guía clínica de prevención del CC del Minsal muestra que, a pesar de la evidencia, no fue posible innovar el examen de tamizaje.…”