Comparison of immediate colposcopy, repeat conventional cytology and hrHPV testing for the clinical management of ASC-US cytology in routine health services of Medellin, Colombia: The ASCUS-COL Trial.

In the context of opportunistic cervical cancer screening settings of low-and-middle-income countries, little is known about the benefits of high-risk human papillomavirus (hrHPV) testing on high-grade cervical abnormality detection among women with atypical squamous cells of undetermined significance (ASC-US) cytology in routine clinical practice. We compared the effectiveness of immediate colposcopy (IC), conventional cytology at 6 and 12 months (colposcopy if ≥ASC-US) (RC), and hrHPV testing (colposcopy if hrHPV-positive) (HPV) to detect cervical intraepithelial neoplasia grade 2 or more severe diagnoses (CIN2+) among women aged 20-69 years with ASC-US in routine care. Participants (n=2,661) were evenly randomized into three arms (n=882 IC, n=890 RC, n=889 HPV) to receive services by routine healthcare providers and invited to an exit visit 24 months after recruitment. Histopathology was blindly reviewed by a quality-control external panel (QC). The primary endpoint was the first QC-diagnosed CIN2+ or CIN3+ detected during three periods: enrolment (≤6 months for IC and HPV, ≤12 months for RC), follow-up (between enrolment and exit visit), and exit visit. The trial is completed. Colposcopy was done on 88%, 42%, and 52% of participants in IC, RC, and HPV. Overall, 212 CIN2+ and 52 CIN3+ cases were diagnosed. No differences were observed for CIN2+ detection (p=0.821). However, compared to IC, only HPV significantly reduced CIN3+ cases that providers were unable to detect during the 2-year routine follow-up (relative proportion 0.35, 95% CI 0.09-0.87). In this context, hrHPV testing was the most effective and efficient management strategy for women with ASC-US cytology.

Resultado anormal de la citología vaginal durante la gestación: 7 años de experiencia / Abnormal result to the vaginal cytology during the gestation: 7 years of experience

Para correlacionar y destacar la importancia de la colposcopia en pacientes gestantes con citología anormal, se hizo un estudio retrospectivo en la ESE Metrosalud-Castilla de Medellín, de Mayo de 1991 a Junio de 1998, se tabularon datos de 127 pacientes, el promedio de edad fue de 24 años, la citología más frecuente fue de LIE de bajo grado (63 por ciento). Se observó que en nuestro medio no existe una buena correlación citología-biopsia, pues se diagnosticaron 2 carcinomas en citologías de bajo grado y 5 carcinomas en citologías de alto grado. Se sugiere por tanto como protocolo de manejo para pacientes embarazadas con citología anormal: colposcopia, toma de biopsia ante hallazgos dudosos, cambios mayores o invasión, conización diagnóstica para sopecha de microinvasión, tratamiento diferido postparto para lesiones NIC y para el cáncer, tratamiento inmediato según normas del Instituto Nacional de Cancerología