Tyrimo tikslas – Įvertinti moterų motyvaciją dalyvauti gimdos kaklelio vėžio profilaktikos programoje bei šeimos gydytojo institucijos vaidmenį vykdant šią programą Šilalės rajone. Tyrimo metodika. Tyrimas buvo atliekamas vykdant 25-60 m. amžiaus moterų, besikreipiančių į šeimos gydytoją, anketinę apklausą. Apklausa atlikta aštuoniose Šilalės rajono gydymo įstaigose. Bendras tiriamųjų skaičius N=250. Rezultatai. Įvertinus moterų, besikreipiančių į šeimos gydytoją Šilalės rajone, aktyvumą dalyvaujant gimdos kaklelio vėžio profilaktikos programoje, nustatyta, kad beveik visos (88 proc.) apklausoje dalyvavusios moterys buvo bent kartą gyvenime pasitikrinusios dėl gimdos kaklelio vėžio. Aktyviau tikrinosi moterys asmeniškai informuotos šeimos gydytojo apie vykdomą gimdos kaklelio vėžio profilaktikos programą telefonu, žinančios, kad pasitikrinimas dėl gimdos kaklelio vėžio moterims nuo 25 iki 60 metų amžiau moterims yra nemokamas, manančios, kad programa yra vykdoma tinkamai bei nurodžiusios, kad šeimos gydytojo vaidmuo vykdant gimdos kaklelio vėžio profilaktikos programą yra svarbus. Tepinėlis dėl gimdos kaklelio vėžio buvo daugiau kartų paimtas moterims, kurios asmeniškai buvo informuotos šeimos gydytojo apie gimdos kaklelio vėžio profilaktikos programą, per pastaruosius 12 mėn. pas savo šeimos gydytoją lankėsi 2-ą kartą ir daugiau, savo sveikatą vertino blogai ir buvo 45-60 metų amžiaus. Beveik pusė (45 proc.) apklaustųjų dėl gimdos kaklelio vėžio bent kartą gyvenime... [toliau žr. visą tekstą] / Aim of the study. To evaluate the motivation of women to participate in cervical cancer prevention program and the role of family physician’s in this program. Methods. Study was carried out among women, aged 25-60 years, who were seeking for family physician’s consultation. The survey was conducted in eight primary health care centers in Šilalė district. The total number of respondents was 250. Results of The Research. Almost all of the women (88%) who participated in the research were checked up for cervical cancer at least once in their life. More active women in cheek-up were those who were personally informed - by telephone, or were - informed by their family doctors, also those who knew that - the Prevention Programme of Cervical Cancer for women aged 25 – 60 is free of charge, who indicated that the role of family doctor‘s is very important in the context of this programme and that the programme is implemented properly. A smear of cervical cancer has been taken more times for women who were informed personally about the Prevention Programme of Cervical Cancer. 45% of the respondents decided to participate in this programme themselves. The main reason why women actively participate in the Prevention Programme of Cervical Cancer is the opportunity to protect themselves from the consequences of serious disease. The respondens pointed out some disadvantages of this programme: the lack of important information about the programme; insufficient public information; not... [to full text]

Orientadores: Luiz Carlos Zeferino, Silvia Helena Rabelo dos Santos / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-13T11:54:26Z (GMT). No. of bitstreams: 1 Westin_MariaCristinadoAmaral_M.pdf: 1208158 bytes, checksum: 4d002e82d5b2c743004678939a62b362 (MD5) Previous issue date: 2009 / Resumo: Introdução: Há evidências de que a incidência do adenocarcinoma do colo do útero tem aumentado, apesar dos programas de rastreamento. Foi a classificação do Sistema de Bethesda, em 1988, que incluiu o diagnóstico citológico relativo às células glandulares atípicas, que não estava presente nas classificações anteriores. Em sua revisão de 2001, o Sistema de Bethesda propôs a subclassificação do diagnóstico citológico de Anormalidades em Células Glandulares em: células glandulares atípicas sem outras especificações (AGC-SOE), células glandulares atípicas favorecendo neoplasia (AGC-FN) e adenocarcinoma in situ (AIS). Os diagnósticos citológicos de AGC constituem um problema clínico em consequência da falta de critérios citomorfológicos bem definidos para sua interpretação, do alto grau de variabilidade interobservador e da falta de achados colposcópicos característicos. O diagnóstico citológico de AIS, embora preditivo de neoplasia glandular, não pode diferenciar de modo preciso entre as formas in situ e invasiva, as quais só podem ser confirmadas pela histologia. Há, na literatura, divergentes opiniões quanto à utilidade desta subclassificação e sua análise é de grande relevância para prática clínica. Objetivo: Analisar a associação entre a classificação citológica do Sistema de Bethesda 2001 para as anormalidades do epitélio glandular cervical e o resultado histológico. Métodos: O estudo foi do tipo corte transversal analítico, prospectivo, realizado no Centro de Atenção Integral à Saúde da Mulher (CAISM), UNICAMP, entre 2002 e 2005, e incluiu uma série consecutiva de 155 mulheres com anormalidades glandulares endocervicais no exame citológico. Destas, 91 mulheres foram incluídas por AGC-SOE, 15 por AGC-FN; 14 por AIS e 35 por diagnóstico combinado de AGC associada à lesão escamosa intraepitelial de alto grau (HSIL). Os diagnósticos de AGC e AIS foram confirmados por dois observadores, de acordo com Sistema de Bethesda 2001. As mulheres com alterações glandulares,de origens outras que não endocervical, não foram incluídas no estudo. No primeiro atendimento foi colhido um segundo esfregaço cervical e realizada colposcopia em todas as mulheres. Foi realizada biópsia ou conização naquelas pacientes que tinham indicação, de acordo com a rotina assistencial do serviço. Todas as mulheres incluídas foram submetidas à ecografia pélvica. A magnitude da associação entre o diagnóstico citológico das anormalidades glandulares e o diagnóstico histológico foi estimada utilizando-se Odds ratio (OR), com respectivo intervalo de confiança (IC) de 95%. Resultados: Das 155 mulheres admitidas no estudo, 126 tiveram avaliação histológica. Tomando-se como referência AGC-SOE, os diagnósticos citológicos de AGC-FN e AIS foram significativamente associados com os resultados histológicos de neoplasia escamosa (NIC 2 ou pior diagnóstico) ou adenocarcinoma (in situ ou invasivo) com valores de odds ratio respectivamente de 10,50 (95% IC: 2,94- 37,55) e 156,00 (95% IC: 17,72-1373,46). Tomando-se como referência AGC-FN, o diagnóstico citológico de AIS foi significativamente associado com os resultados histológicos de neoplasia escamosa ou adenocarcinoma (OR=14,86; 95% IC: 1,53-144,23). Uma associação similar foi observada considerando-se os resultados histológicos de adenocarcinoma (in situ ou invasivo). Nenhuma associação foi observada para neoplasia escamosa analisada isoladamente. Os resultados histológicos de NIC 2 ou pior diagnóstico foram fortemente associados com AGC quando a lesão de alto grau (HSIL) também estava presente (OR=57,60; 95%IC: 18,25-181,76), mas nenhuma associação foi observada com resultado histológico de adenocarcinoma. Conclusões: Há uma associação significante entre as subclassificações da categoria de anormalidades em células glandulares de origem endocervical, propostas pelo Sistema de Bethesda 2001, e diagnósticos histológicos significativos, pois os diagnósticos citológicos de AGC-SOE, AGC-FN e AIS indicam um aumento progressivo de risco para adenocarcinoma. A presença de HSIL associada à AGC representa maior probabilidade de neoplasia escamosa, mas não de adenocarcinoma / Abstract: Introduction: There is evidence indicating that incidence of cervical adenocarcinoma has been increasing, despite the screening programs. The cytological diagnosis of atypical glandular cells, absent from previous versions, was included in the 1988 edition of the Bethesda System (TBS). In its review of 2001, the TBS has proposed the sub-classification of the cytological diagnosis of glandular cells abnormalities as: atypical glandular cells not otherwise specified (AGC-NOS), atypical glandular cells favor neoplastic (AGC-FN) and adenocarcinoma in situ "(AIS). The usefulness of the sub-classification of cytological diagnosis as atypical glandular cells not otherwise specified (AGC-NOS), atypical glandular cells favor neoplastic (AGC-FN) and adenocarcinoma in situ (AIS), as proposed in the 2001 TBS, is a controversial issue, but of great importance in clinical practice. AGC in cervical smears constitutes a clinical problem due to the lack of well-defined cytomorphological criteria for the interpretation of this finding, the high degree of interobserver variability and the lack of characteristic colposcopic features. Moreover, cytological AIS cannot specifically differentiate between AIS and invasive adenocarcinoma, which can only be confirmed by histology. Objective: to analyze the association between the 2001 TBS classification of glandular abnormalities and the histological outcome. Method: This cross-sectional and prospective study was conducted at the Center of Health Care of Women (CAISM), UNICAMP, between 2002 and 2005. The sample comprises a series of 155 women with glandular abnormalities in cervical smear. Of those, 91 women were included due to AGC-SOE, 15 due to AGC-FN, 14 due to AIS and 35 for AGC combined with high grade squamous intraepithelial lesions (HSIL). The diagnoses of AGC and AIS were confirmed by two observers according to the TBS 2001. Women with changes of glandular origin other than endocervical were excluded. In their first visit, a second cervical sample was collected from all women, and colposcopy was performed. A biopsy or a conization was performed when necessary, according to CAISM's protocols. All women underwent pelvic ultrassonography. Odds ratios (OR) with 95% confidence interval (95% CI) were used to evaluate the magnitude of the association between the cytological diagnosis of the glandular abnormalities and the significant histologic diagnosis. Results: Of the 155 women admitted to the study, 126 were submitted to histological examination. Taking as reference AGC-NOS, the cytological diagnosis of AGC-FN and AIS were significantly associated with the histological outcome of squamous neoplasia (CIN or worse) or adenocarcinoma (in situ or invasive) with OR values of 10.50 (95% CI: 2.94-37.55) and 156.00 (95% CI: 17.72-1373.46), respectively. Taking as reference AGC-FN, the cytological diagnosis of AIS was significantly associated with the histological outcome of squamous neoplasia or adenocarcinoma (OR=14.86; 95%CI: 1.53-144.23). Similar associations were observed for the histological outcome of adenocarcinoma, but no association was observed for only squamous neoplasia. Histological outcome of CIN2 or worse was strongly associated with AGC when HSIL was also present (OR = 57.60; 95% CI: 18.25- 181.76), but no association was observed with adenocarcinoma as the stand-alone histological outcome. Conclusions: There is an association between the subclassification of glandular cells abnormalities of endocervical origin proposed by 2001 TBS with significant histological outcomes. The cytological diagnoses of AGC-NOS, AGC-FN and AIS were progressively associated with adenocarcinoma. The histological outcome of squamous neoplasia is frequent but does not differ from these cytological interpretations. The presence of HSIL associated with AGC was associated with a greater probability of squamous neoplasia, but not / Mestrado / Ciencias Biomedicas / Mestre em Tocoginecologia

A l'échelle mondiale, le cancer du col de l'utérus (CCU) constitue un problème majeur de santé publique touchant 528 000 femmes, il est responsable de 266 000 décès chaque année. Son taux d'incidence varie d'un pays à l'autre et reste remarquablement plus élève dans les pays en voie de | développement où l'accès aux soins, même primaires reste précaire. De nombreuses études I épidémiologiques ont démontré qu'environ 99,7 % des cancers du col de l'utérus sont associés à l'infection par des Papillomavirus Humains (HPV) oncogènes, en particulier les HPV16 et 18. Ces données ont permis le développement de vaccins prophylactiques dirigés contre ces deux génotypes viraux. Il s'agit d'un des! cancers les plus faciles à prévenir et à traiter a condition qu'il soit détecté suffisamment tôt et traité| correctement. L'objectif de ce travail de thèse était d'étudier deux populations de femmes à risque du CCU qui vivent sur deux continents différents (Afrique/Europe). Ces deux populations étaient référées auprès de médecins hospitaliers pour des problèmes gynécologiques. La majorité des femmes n'avaient pas été dépistées (femmes marocaines), ou avaient été sous-dépistées selon les recommandations de l'ANAES (femmes françaises de plus de 65 ans). Au cours de cette étude, les femmes ont eu un frottis cervico-utérin (FCU) pour une analyse cytologique et une recherche d'ADN d'HPV, soit par amplification de cible (PCR ; population marocaine), soit par amplification de signa! (test hc2 ; population française). Les échantillons; HPV positifs ont ensuite été génotypes, soit par génotypage complet (INNO-LiPA ; population marocaine),| soit par génotypage partiel (qPCR HPV16,18 et 45 ; population française). Les frottis étaient normaux dans la majorité des cas : chez 81,9% des femmes marocaines et 68,6% des femmes françaises. Les frottis de signification indéterminée (ASC-US) ont été diagnostiqués chez 15,8% des femmes françaises. Les frottis en faveur d'une lésion de bas grade (LGSIL) étaient observes chez 12,9% des femmes marocaines et 7,4% des femmes françaises. Les frottis en faveur d'une lésion de haut grade (HGSIL) étaient de 5,2% chez les femmes marocaines et 4% chez les femmes françaises. Les frottis évocateurs de cancer ont été décelés uniquement dans la population française (2,9%). La prévalence d'HPV était du même ordre de grandeur (23%) dans les 2 populations et augmentait avec la sévérité de la lésion cytologique pour atteindre 75% dans les frottis HGSIL chez les femmes marocaines et plus de 90% chez les femmes françaises. La quasi-totalité des échantillons en faveur d'un CCU étaient infectés par un HPV. Par ailleurs, dans les deux populations, le génotype prévalent dans tous les types de frottis était THPV16, génotype le plus cardnogène. Un tiers (36,2%) de la cohorte des femmes marocaines était infecté par le VIH, qui s'est avéré le plus important facteur prédictif de l'infection HPV, indépendamment des autres facteurs de risqueI étudiés (caractéristiques sociodémographiques, comportement sexuel, tabagisme...). En France, le dépistage du CCU est préconisé tous les trois ans chez les femmes de 25 à 65 ans. Toutefois, les femmes âgées de plus de 65 ans dont l'espérance de vie est élevée et qui n'ont pas été ou qui ont été mal dépistées pourraient bénéficier d'un test HPV dont la Valeur Prédictive Négative est très élevée. Au Maroc, en l'absence de dépistage organise, il est aussi souhaitable de proposer un test HPV dans le cadre du dépistage j du CCU. La vaccination anti-HPV pourrait aussi prévenir ce cancer. / Worldwide, cervical cancer (CC) is a major public health problem affecting 528 000 women and responsible for 266 000 deaths every year. Its incidence rate varies from one country to another and remains remarkably higher in developing countries where access to care, even primary remains precarious. Many epidemiological studies have shown that approximately 99.7% of cancers of the cervix are associated with infection with oncogenic Human Papillomavirus (HPV), especially HPV16 and 18. These data allowed the development of prophylactic vaccines directed against these two viral genotypes. It is one of the easiest cancers to prevent by early detection of precancerous lesions. The objective of this PhD thesis work was to study two populations of women at risk of CC who live on two different continents (Africa / Europe). These two populations were referred to hospital doctors for gynecological problems. The majority of women were not screened (Moroccan women) or were under-screened according to ANAES recommendations (French women over 65 years). At entry in the study, women had a cervical smear for cytology and HPV DNA research, either by target amplification (PCR; Moroccan population) or signal amplification (hc2 test; French population). HPV positive samples were then genotyped, either with full genotyping (INNO-LiPA; Moroccan population) or with partial genotyping (qPCR targeting HPV16,18 and 45; French population). Smears were normal in most cases: in 81.9% of Moroccan women and 68.6 % of French women. Atypical Squamous Cells of Undetermined Significance (ASC-US) were diagnosed in 15.8% of French women. Smears in favour of low grade lesion (LGSIL) were observed in 12.9% of Moroccan women and 7.4 % of French women. Smears in favour of high grade lesion (HGSIL) were in 5.2 % of Moroccan women and 4% of French women. Smears suggestive of cancer were detected only in the French population (2.9%). The prevalence of HPV was of the same order of magnitude (23%) in both populations; and increased with the severity of cytological lesions to reach 75% in HGSIL smears among: Moroccan women and over 90% among French women. Almost ail samples with CC were infected with high risk HPV. Furthermore, in both populations, the most prevalent genotype in ail types of smear wasHPV16, known to be the most carcinogenic. One third (36.2%) of the cohort of Moroccan women was infected with HIV, which was the most powerful predictor of HPV infection, independent of other risk factors studied (sociodemographic characteristics, sexual behavior, smoking ...).In France, CC screening is recommended every three years for women 25 to 65 years. However, women over 65 whose life expectancy is high and who have not been or have been poorly screened could benefit from an HPV test. In Morocco, in absence of organized screening, it is also desirable to provide an HPV test as a part of CC screening. The HPV vaccines could improve the situation by reducing the incidence and mortality from this cancer

Disertacijos objektas naujas citologinio gimdos kaklelio tyrimo panaudojus Shandon PapSpin skystąsias terpes efektyvumo įvertinimas. Žinoma, kad citologinis gimdos kaklelio tepinėlio tyrimas-efektyvus gimdos kaklelio vėžio kontrolės būdas, tačiau jis pasižymi nepakankamu jautrumu sąlygotu nepakankamos tyrimo kokybės. Skystųjų terpių citologinis tyrimas buvo įvertintas dviem etapais: tiriant dalytą gimdos kaklelio medžiagą ( angl.split-sample) fazėje ir nedalytą gimdos kaklelio medžiagą (angl. direct to vial). 2950 moterims buvo atlikti citologiniai tyrimai. Gauti citologinių tyrimų rezultatai buvo palyginti su atitinkamai konizuotosios gimdos kaklelio dalies histologinio tyrimo rezultatais apskaičiuojant citologinių metodų diagnostines vertes, sutarimą tarp citologinio tepinėlio tyrimų ir skystųjų terpių tyrimų. Disertacijoje keliamas klausimas ar citologiniai gimdos kaklelio tyrimai panaudojus skystąsiais terpes yra patikimas ikinavikinės gimdos kaklelio patologijos diagnostikos metodas. Disertacijoje konstatuojama, kad citologiniai gimdos kaklelio tyrimai panaudojus skystąsias terpes yra efektyvus diagnostikos metodas diagnozuojant ikinavikinius gimdos kaklelio pakitimus. Pagrindiniai metodo privalumai –statistiškai reikšmingas netinkamų ir ASC ( atipinių plokščiojo epitelio ląstelių) tyrimų kiekio sumažėjimas. Disertacijoje taip pat daug dėmesio skiriama Žmogaus papilomos viruso nustatymui iš skystosios likusios po citologinio tyrimo terpės ir konizuotosios gimdos... [toliau žr. visą tekstą] / The study comparing the effectiveness of a novel liquid-based Pap test (the PapSpin) with the conventional Pap smear. The impetus behind the study is meritorious: although the conventional Pap smear has been highly effective in diminishing mortality from cervical cancer, it is not perfect. It suffers from inconsistency in cell thickness and occasional obscuring blood, which hinder accurate evaluation. An alternative preparation method, one that would reduce the amount of blood and provide for a more consistent, thin layer of cells would make screening easiser and more accurate. The several performance characteristics examined in the study: Rate of unsatisfactory smears, rate of "atypical" smears (smears with an interpretation of "atypical squamous cells of undetermined significance"), sensitivity, specificity, positive predicitve value (PPV), and negative predictive value (NPV), based on histologic correlation and suitability for human papillomavirus (HPV) testing. The study consists of two principal parts. In the first part, the cervical sample collected was split into two preparations ("split sample"): a conventional smear was prepared first, then the residue left on the collection device was used to prepare a PapSpin slides. In the second part ("direct to vial"), the entire cervical sample was used to prepare a PapSpin slide. In the "split sample" study a significant reduction in the proportion of unsatisfactory and "atypical" cases was found when slides were prepared... [to full text]

The study comparing the effectiveness of a novel liquid-based Pap test (the PapSpin) with the conventional Pap smear. The impetus behind the study is meritorious: although the conventional Pap smear has been highly effective in diminishing mortality from cervical cancer, it is not perfect. It suffers from inconsistency in cell thickness and occasional obscuring blood, which hinder accurate evaluation. An alternative preparation method, one that would reduce the amount of blood and provide for a more consistent, thin layer of cells would make screening easiser and more accurate. The several performance characteristics examined in the study: Rate of unsatisfactory smears, rate of "atypical" smears (smears with an interpretation of "atypical squamous cells of undetermined significance"), sensitivity, specificity, positive predicitve value (PPV), and negative predictive value (NPV), based on histologic correlation and suitability for human papillomavirus (HPV) testing. The study consists of two principal parts. In the first part, the cervical sample collected was split into two preparations ("split sample"): a conventional smear was prepared first, then the residue left on the collection device was used to prepare a PapSpin slides. In the second part ("direct to vial"), the entire cervical sample was used to prepare a PapSpin slide. In the "split sample" study a significant reduction in the proportion of unsatisfactory and "atypical" cases was found when slides were prepared... [to full text] / Disertacijos objektas naujas citologinio gimdos kaklelio tyrimo panaudojus Shandon PapSpin skystąsias terpes efektyvumo įvertinimas. Žinoma, kad citologinis gimdos kaklelio tepinėlio tyrimas-efektyvus gimdos kaklelio vėžio kontrolės būdas, tačiau jis pasižymi nepakankamu jautrumu sąlygotu nepakankamos tyrimo kokybės. Skystųjų terpių citologinis tyrimas buvo įvertintas dviem etapais: tiriant dalytą gimdos kaklelio medžiagą ( angl.split-sample) fazėje ir nedalytą gimdos kaklelio medžiagą (angl. direct to vial). 2950 moterims buvo atlikti citologiniai tyrimai. Gauti citologinių tyrimų rezultatai buvo palyginti su atitinkamai konizuotosios gimdos kaklelio dalies histologinio tyrimo rezultatais apskaičiuojant citologinių metodų diagnostines vertes, sutarimą tarp citologinio tepinėlio tyrimų ir skystųjų terpių tyrimų. Disertacijoje keliamas klausimas ar citologiniai gimdos kaklelio tyrimai panaudojus skystąsiais terpes yra patikimas ikinavikinės gimdos kaklelio patologijos diagnostikos metodas. Disertacijoje konstatuojama, kad citologiniai gimdos kaklelio tyrimai panaudojus skystąsias terpes yra efektyvus diagnostikos metodas diagnozuojant ikinavikinius gimdos kaklelio pakitimus. Pagrindiniai metodo privalumai –statistiškai reikšmingas netinkamų ir ASC ( atipinių plokščiojo epitelio ląstelių) tyrimų kiekio sumažėjimas. Disertacijoje taip pat daug dėmesio skiriama Žmogaus papilomos viruso nustatymui iš skystosios likusios po citologinio tyrimo terpės ir konizuotosios gimdos... [toliau žr. visą tekstą]