Tracking of cellular atypes of the cut of uterus of women in Primary Care

quantitative, retrospective and cross-sectional study, with analysis of 190 medical records of women who had atypical results from the cervical cytopathological exam collection from 2012 to 2014.

Results:

the most frequent atypias found were possibly Non-neoplastic squamous (ASC-US, 57.4%) and Low-grade intraepithelial lesion (LSIL, 23.2%). The time elapsed between the exam and the result was 24 days. The professional’s conduct after the result of the last cervical cytopathology was adequate for 51.1% of women.

Conclusions:

there is a need to improve the cervical cancer screening program and correctly target the atypia identified, aiming at the access of the target population for the diagnostic investigation and treatment of precursor lesions of cervical cancer.

Descriptors:
Cervical Intraepithelial Neoplasia; Mass Screening; Uterine Cervical Dysplasia; Primary Health Care; Health Promotion

Variable	n (%)	95% confidence interval
Total	190 (100.0%)	-
ASC-US: Atypical cells of undetermined significance, possibly non-neoplastic, squamous	109 (57.4%)	(50.0 % - 64.5 %)
ASC-H: Atypical cells of undetermined significance, squamous in which a high-grade lesion cannot be ruled out	8 (4.2%)	(1.8 % - 8.1 %)
AGC: Atypical cells of undetermined significance, possibly non-neoplastic glandular cells	22 (11.6%)	(7.4 % - 17.0 %)
AGC: Atypical cells of undetermined significance, glandular in which a high-grade lesion cannot be ruled out	1 (0.5%)	(0.0 % - 2.9 %)
LSIL: Squamous cell atypias, low-grade intraepithelial lesion (comprising HPV cytopathic effect and grade I cervical intraepithelial neoplasia)	44 (23.2%)	(17.4 % - 29.8 %)
HSIL: Atypias in squamous cells, high-grade intraepithelial lesion (comprising grade II and III cervical intraepithelial neoplasms)	6 (3.1%)	(1.2 % - 6.7 %)

Variable	Mean	Standard deviation	Minimum	Maximum	1^st Quartile	Median	3^rd Quartile	n	p
Time between taking the exam and arriving at BHU (days)	27.5	12.9	11.0	89.0	20.0	25.0	30.0	175	0.046
Adequate	25.7	11.2	11.0	80.0	19.0	23.0	28.5	97
Not adequate	29.7	14.6	13.0	89.0	20.0	27.0	33.0	78
Time between taking the exam and consulting at BHU (months)	2.9	2.1	1.0	12.0	2.0	2.0	3.0	175	0.124
Adequate	3.1	2.4	1.0	12.0	2.0	2.0	4.0	97
Not adequate	2.6	1.7	1.0	9.0	2.0	2.0	3.0	78

	n	%
ASC-US: Atypical cells of undetermined significance, possibly non-neoplastic squamous	109	100.0
Adequate
Repeat the exam in six months	74	67.8
Not adequate
Priority referral for medical consultation	3	2.8
Colposcopy request	18	16.5
Was not conducted
Was not conducted, as the patient left the BHU area	3	2.8
Was not conducted, because the patient did not come to get the result of the OC	11	10.1
ASC-H: Atypical cells of undetermined significance, squamous in which a high-grade lesion cannot be ruled out	8	100.0
Adequate
Colposcopy request	4	50.0
Not adequate
Priority referral for medical consultation	2	25.0
Repeat the exam in six months	2	25.0
AGC: Atypical cells of undetermined significance, possibly non-neoplastic glandular cells	22	100.0
Adequate
Colposcopy request	10	45.5
Not adequate
Repeat the exam in six months	11	50.0
Was not conducted
Patient abandoned BHU area	1	4.5
AGC: Atypical cells of undetermined significance, glandular in which a high-grade lesion cannot be ruled out	1	100.0
Not adequate
Priority referral for medical consultation	1	100.0
LSIL: Squamous cell atypia, low-grade intraepithelial lesion (comprising HPV cytopathic effect and grade I cervical intraepithelial neoplasia)	44	100.0
Adequate
Repeat the exam in six months	6	13.6
Not adequate
Priority referral for medical consultation	3	6.8
Colposcopy request	35	79.6
HSIL: Atypia in squamous cells, high-grade intraepithelial lesion (comprising grade II and III cervical intraepithelial neoplasms)	6	100.0
Adequate
Colposcopy request	3	50.0
Not adequate
Priority referral for medical consultation	3	50.0

Variable	Final outcome								Total
	Annual gynecological routine		Semi-annual Semester gynecological routine		In high-risk treatment		Abandonment of treatment		Total
	n	%	n	%	n	%	n	%	n	%
Result of the last cervical cytopathology	76	40.0%	66	34.7%	10	5.3%	38	20.0%	190	100.0%
ASC-US: Atypical cells of undetermined significance, possibly non-neoplastic, squamous	56	51.3%	26	23.9%	3	2.8%	24	22.0%	109	100.0%
ASC-H: Atypical cells of undetermined significance, squamous in which a high- grade lesion cannot be ruled out	0	0.0%	6	75.0%	2	25.0%	0	0.0%	8	100.0%
AGC: Atypical cells of undetermined significance, possibly non-neoplastic glandular cells	8	36.4%	7	31.8%	0	0.0%	7	31.8%	22	100.0%
AGC: Atypical cells of undetermined significance, glandular in which a high- grade lesion cannot be ruled out	0	0.0%	0	0.0%	1	100.0%	0	0.0%	1	100.0%
LSIL: Atypia in squamous cells, low- grade intraepithelial lesion (comprising HPV cytopathic effect and grade I cervical intraepithelial neoplasia)	12	27.3%	26	59.0%	1	2.3%	5	11.4%	44	100.0%
HSIL: Atypia in squamous cells, high- grade intraepithelial lesion (comprising grade II and III cervical intraepithelial neoplasms)	0	0.0%	1	16.7%	3	50.0%	2	33.3%	6	100.0%

Variable	Conduct						Total
	Adequate		Not adequate		There was no conduct		Total
	n	%	n	%	n	%	n	%
Result of the last cervical cytopathology	97	51.1%	78	41.0%	15	7.9%	190	100.0%
ASC-US: Atypical cells of undetermined significance, possibly non-neoplastic, squamous	74	67.9%	21	19.3%	14	12.8%	109	100.0%
ASC-H: Atypical cells of undetermined significance, squamous in which a high-grade lesion cannot be ruled out	4	50.0%	4	50.0%	0	0.0%	8	100.0%
AGC: Atypical cells of undetermined significance, possibly non-neoplastic glandular cells	10	45.5%	11	50.0%	1	4.5%	22	100.0%
AGC: Atypical cells of undetermined significance, glandular in which a high-grade lesion cannot be ruled out	0	0.0%	1	100.0%	0	0.0%	1	100.0%
LSIL: Squamous cell atypia, low-grade intraepithelial lesion (comprising HPV cytopathic effect and grade I cervical intraepithelial neoplasia)	6	13.6%	38	86.4%	0	0.0%	44	100.0%
HSIL: Atypia in squamous cells, high-grade intraepithelial lesion (comprising grade II and III cervical intraepithelial neoplasms)	3	50.0%	3	50.0%	0	0.0%	6	100.0%

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[1] Corresponding author: Jamile Mika Yoshikawa Kurebayashi. E-mail: jamile.mika@yahoo.com.br