Adequabilidade dos esfregaços cervicais frente aos principais fatores pré-laboratoriais que podem interferir na análise do exame citopatológico.
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Data
2009-02-16
Autores
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Universidade Federal de Goiás
Resumo
Background: Cervical cancer in Brazil has one of the highest incidence rates.
Screening this neoplasia is effective when a cytopathological test stained by
Papanicolaou method is performed. However, the quality of cytopathological
samples directly influences the screening effectiveness. Eventhough, this
method has been criticized due to the high rates of false-negative, due to
collection errors, routine scrutiny and the interpretation of cytological changes.
Amongst the collection errors, the absence of endocervical cells and bad
fixation are highlighted as one of the main concerns. Objectives: to assess the
profile of professionals in charge of collecting cytopathological samples as well
as verify whether the experience time and the working conditions are
associated with sample adequability, verify the main difficulties and easiness
reported by the professionals regarding cervical smears collection by using
different fixation techniques, verify which fixation technique shows better
performance concerning samples adequability and whether the fixation
technique influences the detection of precursory injuries; verify the frequency of
satisfactory cervical smears, the factors which could partially make samples
obscure or make them unsatistactory for the analysis, as well as verify the
presence or absence of transformation zone, and whether the presence of
these cells is associated with the detection of cervical cancer precursory
injuries. Methodology: 19 professionals -doctors and nurses- in charge of
collecting cytopathological samples took part in this study. 1,354
cytopathological smears were included in this study, which were divided into
three groups, submitted to different fixation techniques and distributed in the
following manner: first group: 414 smears fixed with alcohol 95%; second group:
445 fixed with dropping fixation (alcohol 95% + polyethylene glycol) and third
group: 495 fixed with spray (alcohol 95% + polyethylene glycol). The cervical
material collected was referred to the cytology sector at the Rômulo Rocha
Clinical Analyses Center and submitted to scrutiny routine regardless to the
fixation technique. The cytopathological outcomes were classified in
accordance with Brazilian Nomenclature for Cervical Diagnoses. At the end of
the study, a questionnaire was applied to the professionals in which they
reported difficulties and easiness concerning the use of different techniques.
Data was inserted and processed in the Epi Info 3.3.2 software, and for statistic
analysis we used the SAS 9.1.3 software. Outcomes: from the 19 professionals
in charge of cytopathological screening 16 (84.2%) are nurses and 3 (15.8%)
are doctors. From the 19 professionals in charge of collection, 58% pointed the
spray technique as of very easy handling. In the limited smears the most
frequent obscuring factor was leukocyte infiltration followed by dissecation,
whereas for the unsatisfactory the majority was of dissecation followed by
hypocellular material. Conclusions: this study showed that spray fixation
technique had the worst performance concerning adequability of sample when
compared to alcohol and drops, and that the professionals considered the spray
fixation as of easier handling. There was no association between the precursory
injuries diagnosis and the fixation technique used. The experience time and the
Abstract
proper collection environment influenced the quality of cervical material samples
and the alcohol 95% fixation technique had the highest rate of difficulty
reported, when compared to the drop and spray fixation. We also observed that
the transformation zone representation was significant both for the most severe
and less severe cervical cancer precursory injuries.
Descrição
Palavras-chave
Câncer de colo do útero , Adequabilidade dos esfregaços
cervicais , Coleta dos exames citopatológicos , Técnicas de fixação , Cervical cancer , Cervical smears adequability , Cytopathological test collection , Fixation techniques , 1.Controle do câncer de colo do útero 2. Adequabilidade dos esfregaços
cervicais 3. Coleta dos exames citopatológicos 4. Técnicas de fixação
Citação
MARTINS, Marcelo Rodrigues. Adequacy of cervical smears before the main factors
pre-lab that can interfere with the analysis of cervical screening.. 2009. 96 f. Dissertação (Mestrado em Ciências da Saúde - Medicina) - Universidade Federal de Goiás, Goiânia, 2009.