MPH, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 2009 / Introduction: Cervical cancer is caused by persistent infection with high-risk Human Papilloma Virus (HPV) and is a leading cause of cancer deaths in South African women aged 15-65years. We estimated prevalence of abnormal (Atypical squmous cells of unknown significance to invasive cervical cancer) cervical cytology and associated cofactors in 18-35-year old women who tested negative for Human Immuno deficiency Virus (HIV). Method: This cervical lesion study was secondary analysis of data collected during a Microbicide Feasibility Study (MFS). MFS recruited 1100 women from public health care facilities. Women were interviewed and socio-demographic, sexual behaviour and clinical information was collected. If HIV negative, cervical and vaginal swabs were collected for Pap smear and laboratory testing for sexually-transmitted infections (STI). For the cervical lesion study, 808 women were eligible and 752 were enrolled in the study. Associations with abnormal cervical cytology were analysed using multiple logistic regression, and were reported as adjusted odds ratio (AOR) with a 95% confidence interval (CI). Results: We analysed 570 cytology specimens. Prevalence of abnormal cervical cytology was 6.7% (95% CI 4.8-9.0). Women who had an abnormal cervical cytology result were more likely than those with normal cytology results to report abnormal vaginal discharge (OR 2.33; 95% CI 1.07-5.06; p=0.03). They were also more likely to have more than one child (OR 2.21; 95% CI 1.00-4.87; p=0.05). v Discussion and conclusion: Our study showed that LSIL is common in this younger age group. Because HPV infection and thus abnormal cervical cytology are high among the younger population, this result is not unexpected. Since most LSIL regress naturally, our data support the current South African screening protocol for cervical cancer.

MMed(Obstetrics and Gynaecology) / Introduction Against the high background rate of HIV among our antenatal clinic attendees, 30.3% in Gauteng in 2007, and the importance of cancer of the cervix as a health issue; this study was undertaken to determine the rate of abnormality found in cervical smears performed on HIV positive women attending the postnatal clinic at Johannesburg Hospital. The degree of abnormality and where possible its management, was reviewed. Secondly it was determined whether the immune status, namely the WHO clinical stage, CD4 cell count and viral load, correlated with the Pap smear results. Lastly patients were also analyzed according to the treatment received for HIV and their Pap smear results. Patients and Methods The study is a retrospective record review. All the patients who attended the postnatal clinic (PNC) between October 2005 and the end of July 2006, who had a Pap smear, were included. Follow-up test results were collected to the end of June 2007. A total of 324 patients attended the clinic in the study time period, of which 248 (76.5%) had a Pap smear done and 76 (23.5%) did not. iv Results The main results of interest were as follows – 131 patients (52.8%) had normal Pap smears, 64(25.8%) had LGSIL, 32 (12.9%) had HGSIL, 10 (4.0%) had ASCUS and 11 (4.4%) had Pap smears that could not be classified. In total 47.2% of the Pap smears were abnormal. There was one case of malignancy developing after an abnormal Pap smear. Patients with abnormal Pap smears tended to have a lower mean CD4 cell count while the viral load and WHO Stage did not appear to have an impact on the final analysis of the Pap smears. Conclusion The rates of cervical abnormality in HIV sero-positive patients attending the Johannesburg Hospital postnatal clinic are much higher (47.2%) than would be expected in the general population (10%), with a significant portion requiring follow-up investigation and management. It is however preferable to deal with cervical cytological abnormalities comprehensively during the screening phase rather than trying to manage a potential increase in cervical cancer cases.

OBJECTIVE: The incidence of endocervical adenocarcinoma has increased steadily over the past two decades. Since the Bethesda System was introduced, the diagnosis of atypical glandular cells of undetermined significance (AGUS) has also risen and now accounts for 0.461.83% of all cervical (Pap) smears. The purpose of this study was to evaluate the significance of a diagnosis of A GUS using cytohistologic correlation. STUDY DESIGN: A retrospective review of archival material from 1993 through 1996 identified 64 patients who had smears diagnosed as AGUS and had a subsequent surgical biopsy. The smears were reviewed and cytologic features analyzed and correlated with the histologic diagnosis. RESULTS: On biopsy, 3 (5%) of the 64 cases showed endocervical adenocarcinoma in situ (AIS) (1 case with invasive adenocarcinoma also), 14 (22%) had a benign glandular lesion (endocervical polyp, tubal metaplasia, microglandular hyperplasia, reactive changes), 35 (54%) had squamous intraepithelial lesion (SIL) (15 diagnosed on the original smear), and 12 (19%) had no abnormality. Among the cytologic criteria evaluated, feathering (P = .01), palisading (P < .001) and chromatin clearing (P = .002) were shown to have a significant association with the histopathologic diagnosis of AIS/adenocarcinoma. These features were also useful in distinguishing AIS/adenocarcinoma from SIL and benign glandular changes from AIS/adenocarcinoma but not benign/reactive glandular changes from SIL. CONCLUSION: A diagnosis of AGUS correlated with a clinically significant lesion in the majority of cases. Squamous dysplasia (SIL) was the most common lesion identified. The presence of feathering, nuclear palisading and chromatin clearing increased the likelihood of a histologic diagnosis of AIS/adenocarcinoma.

Submitted by JÚLIO HEBER SILVA (julioheber@yahoo.com.br) on 2016-11-29T18:02:39Z No. of bitstreams: 2 Dissertação - Leonardo Izidório Cardoso Filho - 2016.pdf: 4542695 bytes, checksum: e9aaacd7d0b4060134aa83a21c36afd6 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Jaqueline Silva (jtas29@gmail.com) on 2016-11-30T15:37:49Z (GMT) No. of bitstreams: 2 Dissertação - Leonardo Izidório Cardoso Filho - 2016.pdf: 4542695 bytes, checksum: e9aaacd7d0b4060134aa83a21c36afd6 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-11-30T15:37:49Z (GMT). No. of bitstreams: 2 Dissertação - Leonardo Izidório Cardoso Filho - 2016.pdf: 4542695 bytes, checksum: e9aaacd7d0b4060134aa83a21c36afd6 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-04-06 / Introduction: cervical cancer is the third cause of women’s death by cancer in the world and its incidence is linked to high-risk oncogenic human papillomavirus (HPV). The cytodiagnosis and tracking of the disease are made by the Papanicolaou technique. Quality control programs have been implemented in order to correct errors of diagnosis, particularly with regard to false-negative results. Objective: to evaluate the internal quality control indicators and quality management program in the section of cytopathology of a university laboratory in the years 2007-2014. Methods: All results of cervical smears tests (taken from the SISCAN – Sistema de Informação do Câncer – The Cancer Information System) of women aged ≥15 years at the time of Pap smear specimen collection during January 2007 to December 2014. The final results of the cytopathology examinations were classified in accordance with the Bethesda System. The variables included in the database were woman’s name, date of birth, and age at time of collection (15–30, 31–40 and >40 years). Results: In this period 50,286 tests were carried out, 44,386 (91.34%) being negative for malignancy and 4,209 (8.66%) abnormal. The positivity rate was 8.69%; the percentage of tests consistent with ASC (Atypical Squamous Cells), between satisfactory exams was 4.12%; the percentage of tests compatible with ASC among abnormal tests was 47.87%; the ASC/SIL (Squamous Intraepithelial Lesion) ratio was 0.97 and the percentage of HSIL (High Grade intraepithelial Lesion squamous high degree) between satisfactory tests was 2.21%, and false-negative results in 5-years retrospective review was 4.97%. Conclusion: The rates obtained were uniforms over the years and within the recommended values. This demonstrates the efficiency and linearity of the internal quality control, reflected in the commitment of the team involved in, through continuing education, whose goal is to detect and correct false-negative results. / Introdução: o câncer do colo do útero é a terceira causa de óbito de mulheres por câncer no mundo e sua incidência está ligada ao papilomavírus humano (HPV) de alto risco oncogênico. O diagnóstico citopatológico e o rastreamento dessa doença são feitos por meio da técnica de Papanicolaou. Programas de controle de qualidade têm sido implementados a fim de corrigir erros de diagnóstico, sobretudo no que se refere a resultados falso-negativos. Objetivo: avaliar os indicadores do controle interno da qualidade e gestão da qualidade na seção de Citopatologia do Laboratório Rômulo Rocha, da Faculdade de Farmácia, da Universidade Federal de Goiás entre os anos de 2007 a 2014. Métodos: todos os resultados dos esfregaços cervicais (retirados do SISCAN – Sistema de Informação Câncer) de mulheres com idade ≥ 15 anos na época da colheita da amostra de Papanicolaou durante janeiro de 2007 a dezembro de 2014. Os resultados finais dos exames Citopatologia foram classificados de acordo com o sistema Bethesda. As variáveis incluídas no banco de dados foram o nome da mulher, data de nascimento e a idade no momento da colheita (15 – 30, 31-40 e > 40 anos). Resultados: foram realizados neste período 50.286 exames, sendo 44.386 (91,34%) considerados como negativos para lesão intraepitelial escamosa e 4.209 (8,66%) alterados. O índice de positividade foi de 8,69% (valores esperados entre 3% e 10%); o percentual de exames compatíveis com ASC (Atypical Squamous Cells – Células escamosas atípicas), entre os exames satisfatórios (valores esperados entre 4% e 5%) foi 4,12%; o percentual de ASC entre os exames alterados, 47,87%; a razão ASC/SIL (Squamous Intraepithelial Lesion – Lesão intraepitelial escamosa) (não superior a 3) foi 0,97 e o percentual de exames compatíveis com HSIL (High Grade Squamous Intraepithelial Lesion – Lesão intraepitelial escamosa de alto grau), 2,21%. Os resultados falso-negativos na revisão retrospectiva de 5 anos foi de 4,97%. Conclusão: os índices obtidos foram uniformes ao longo dos anos e dentro dos valores preconizados. Isso demonstra a eficiência e linearidade do controle interno de qualidade, refletidas no comprometimento da equipe envolvida na liberação dos laudos citopatológicos, através de educação continuada, cujo objetivo é detectar e corrigir resultados falso-negativos.

Thesis (MMed) -- Stellenbosch University, 2010. / Bibliography / Objectives: To describe the establishment of a colposcopy service in a district hospital in a rural sub-district and to assess its impact on the uptake of colposcopy. Design: A retrospective double group cohort study using a laboratory database of cervical cytology results, clinical records and colposcopy clinic registers. Setting: The Overstrand sub-district in the Western Cape: 80 000 people served by 7 clinics and a district hospital in Hermanus, 120 km from its referral hospitals in Cape Town and Worcester. A colposcopy service was established at Hermanus Hospital in 2008. Subjects: All women in the Overstrand sub-district who required colposcopy on the basis of cervical smears done in 2007 and 2009. Outcome measures: The number of women booked for colposcopy at distant referral hospitals in 2007 and at the district hospital is 2009, the proportion of those women who attended colposcopy, the time from cervical smear to colposcopy, comparison between the two years. Results: The uptake of colposcopy booked for distant referral hospitals was 67% in 2007. The uptake improved by 18% to 79% for the local district hospital colposcopy service in 2009 (p=0.06). When analysed excluding patients from an area with no transport to the district hospital, the improvement was more marked at 22% (p=0.02). The delay from cervical smear to colposcopy improved significantly from 170 to 141 days (p=0.02). Conclusion: The establishment of a colposcopy service in a rural sub-district increased the uptake of colposcopy and decreased the delay from cervical smear to colposcopy. This district hospital colposcopy service removed 202 booked patients in one year from the colposcopy load of its referral hospitals.

Made available in DSpace on 2014-07-29T15:29:06Z (GMT). No. of bitstreams: 1 Dissertacao marcelo.pdf: 1119512 bytes, checksum: 984cc3388c7964bc78803aad571255d2 (MD5) Previous issue date: 2009-02-16 / 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. / Introdução: O câncer de colo do útero apresenta elevada taxa de incidência no Brasil quando comparado com outras neoplasias. O exame citopatológico, apesar de ser o método de escolha na triagem dessa neoplasia, vem sofrendo críticas devido aos altos índices de resultados falso-negativos, provenientes de erros da coleta, do escrutínio de rotina e da interpretação das alterações citológicas. Dentre os erros da coleta, a ausência de células endocervicais e a má fixação se destacam como os principais problemas. Objetivos: Avaliar o perfil dos profissionais responsáveis pela coleta do exame citopatológico e verificar se o tempo de experiência e as condições de trabalho estão associados com a adequabilidade da amostra. Identificar as principais dificuldades e facilidades relatadas pelos profissionais em relação à coleta dos esfregaços cervicais utilizando diferentes técnicas de fixação. Verificar qual é a técnica de fixação que apresenta melhor desempenho em relação à adequabilidade da amostra e se a técnica de fixação influencia na detecção de lesões precursoras. Verificar a freqüência dos esfregaços cervicais satisfatórios e de fatores que podem obscurecer parcialmente a amostra ou torná-la insatisfatória para análise, bem como, verificar a freqüência dos esfregaços cervicais com representação dos componentes da junção escamo-colunar (JEC), e se a presença desses componentes influencia na detecção de lesões precursoras do câncer do colo do útero. Metodologia: Participaram desse estudo 19 profissionais, dentre estes, médicos e enfermeiros, responsáveis pela coleta dos exames citopatológicos do colo do útero. Foram incluídos nesse estudo 1.354 esfregaços citopatológicos divididos em três grupos, submetidos às diferentes técnicas de fixação e distribuídos da seguinte maneira, o primeiro grupo constituído por 414 esfregaços fixados com álcool a 95%, o segundo grupo por 445 utilizando o fixador em gotas (álcool 95% + polietilenoglicol) e o terceiro grupo por 495 utilizando o fixador em spray (álcool 95% + polietilenoglicol). Após a coleta, os esfregaços foram encaminhados ao Centro de Análises Clínicas Rômulo Rocha e submetido à mesma rotina para análise, independente da técnica de fixação. Os resultados citopatológicos foram classificados de acordo com a Nomenclatura Brasileira para Laudos Cervicais. Após a finalização das coletas, os profissionais responderam um questionário relatando as facilidades e dificuldades frente ao uso das diferentes técnicas de fixação. Os dados foram digitados e processados no programa Epi Info versão 3.3.2 e para os cálculos estatísticos utilizou-se o programa SAS versão 9.1.3. Resultados: Dos 19 profissionais responsáveis pela coleta do exame citopatológico, 84,2% são enfermeiros e 15,8% médicos. Dentre os esfregaços classificados como satisfatórios para análise, a maioria foram coletados por profissionais com mais de cinco anos de experiência, e em ambientes classificados como bom ou ótimo. Dos esfregaços insatisfatórios para análise devido ao dessecamento utilizou-se em, 93,3% deles, a técnica em spray (p= 0,02). Apesar disso, 58% dos profissionais responsáveis pela Resumo coleta cervical apontaram a técnica em spray de muito fácil manuseio. Os fatores obscurecedores mais freqüentes foram dessecamento, infiltrado leucocitário e material hipocelular. Dentre os esfregaços satisfatórios para a análise, 92,7% apresentaram componentes da JEC e a presença destes componentes foi significativa nas lesões mais graves e menos graves (p<0,0001). Conclusões: A técnica de fixação em spray apresentou pior desempenho em relação à adequabilidade da amostra quando comparado com álcool e gotas. Não houve associação entre o diagnóstico de lesões precursoras e a técnica de fixação utilizada. O tempo de experiência e o ambiente de coleta adequado influenciaram na qualidade da amostra do material cervical. A técnica de fixação em álcool 95% teve maior índice de dificuldades relatadas, quando comparada com a fixação em gotas e em spray. A representação da junção escamo-colunar nos esfregaços mostrou-se significativa tanto para o diagnóstico de lesões mais graves quanto as menos graves .