RESUMO
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.
RESUMO
En este artículo se hace un recuento de la importancia de la citología vaginal como estudio de rutina en la mujer con vida sexual activa. Se analizan los tres aspectos básicos de dicho examen que son la obtención adecuada de la muestra, el informe apropiado del patólogo y su interpretación correcta por el clínico; un adecuado control de estos factores ayudará a disminuir su alta rata de resultados falsos negativos, con el obvio beneficio para las pacientes. Se insiste en darle mucha importancia a cualquier informe de citología anormal, que a la larga evitará el desarrollo de neoplasias invasoras.
Assuntos
Humanos , Feminino , Esfregaço Vaginal , Esfregaço Vaginal/normas , Esfregaço Vaginal/tendências , Esfregaço Vaginal/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controleRESUMO
Se presentan los resultados de un estudio hecho en 38 pacientes con diagnostico clinico y por laboratorio de Rinitis Vasomotora y 14 controles, que asistieron a la consulta externa otorrinolaringologica del Hospital Universitario San Vicente de Paul, en Medellin, Colombia, entre mayo de 1987 y diciembre de 1988. Se encontro que la RV en nuestro medio es una enfermedad que predomina en mujeres jovenes entre 12 y 34 anos con obstruccion nasal de mas de un ano de evolucion como principal motivo de consulta y tumefaccion de cornetes con buena respuesta vasoconstrictora como hallazgo predominante al examen fisico. Los estudios realizados (IgE serica total, prueba de Anderson, espirometria, recuento de celulas metacromaticas en raspado de mucosa nasal y biopsia de cornete inferior) no fueron de valor diagnostico. Como hallazgo importante se encontro mediante la espirometria, en el 73% de los pacientes, obstruccion pulmonar en ausencia de sintomatologia respiratoria inferior. p<0.05).8
We performed a case-control study of 38 cases of vasomotor rhinitis (VR) diagnosed at the Otorrhinolaryngology Outpatient Clinic at Hospital Universitario San Vicente de Paúl, Medellin, Colombia, between May 1987 and December 1988. These cases were proved both clinically and by laboratory evaluation and were compared to 14 controls. VR was predominant in young women aged 12 to 34 years (75%). Nasal congestion of more than one year evolution was the outstanding symptom and edematous turbinates with good vasoconstriction retraction was the predominant sign on physical examination. The tests performed (serum total lgE, Anderson's test, pulmonary function tests, nasal metachromatic cell counts and turbinate biopsy) had no diagnostic value. One Important finding was the spirometric detection of pulmonary obstruction without clinical manifestations that was observed in 73% of the cases (p
