Made available in DSpace on 2014-06-11T19:30:59Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-07-19Bitstream added on 2014-06-13T20:01:19Z : No. of bitstreams: 1 lima_cf_dr_sjc.pdf: 574864 bytes, checksum: cf6904339556fc2b74794049e1675fbe (MD5) / A survivina é uma proteína inibidora da apoptose que desempenha papel de controle no ciclo celular e no mecanismo de carcinogênese. Este trabalho teve como proposição verificar a correlação clinicopatológica da expressão da survivina nas diferentes condições relacionadas à carcinogênese intra-bucal humana, o que pode ser útil para destacar aspectos importantes das etapas da carcinogênese bucal. Foram constituídos três grupos, formados em parte por material citológico coletado de pacientes participantes do Programa Ambulatorial de Tratamento de Tabagismo do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (INCOR-HCFMUSP); e por material que se encontra incluído em blocos de parafina no Laboratório de Patologia Bucal da Faculdade de Odontologia de São José dos Campos FOSJC – UNESP. O primeiro grupo foi constituído por material citológico obtido do bordo lateral lingual esquerdo e soalho bucal de 30 pacientes que fumavam mais de 20 cigarros/dia/10anos e que não apresentavam histórico de neoplasia bucal maligna, nem sinais clínicos visíveis no local avaliado; o segundo grupo foi constituído por amostras teciduais de 21 pacientes com lesões brancas clinicamente classificadas como leucoplasias. O terceiro grupo foi formado por 42 amostras teciduais de pacientes com diagnóstico de carcinoma epidermóide bucal. Os pacientes que foram submetidos à citologia esfoliativa foram examinados através de anamnese, exame clínico extra e intra -bucal. A citologia esfoliativa foi realizada com cytobrush para obtenção de duas lâminas de cada local selecionado. Após a realização da imunoistoquímica com anticorpo primário anti-survivina as lâminas foram analisadas qualitativamente através da microscopia óptica. Uma lâmina de assoalho e uma de língua foram coradas e avaliadas pelo método de Papanicolaou... / Survivin is an inhibitor of apoptosis protein that plays a role in cell cycle control and the mechanism of carcinogenesis. The aim of the present work was to study the clinicopathological correlation of survivin expression in different conditions related to intra-oral carcinogenesis. This may be useful to highlight important aspects of oral carcinogenesis steps. Three groups were analyzed. They were formed in part by cytological material collected from patients of Heart Institute’s Patient Center and the Smoking Cessation Program of the University Hospital, University of São Paulo Medical School (INCOR-HCFMUSP) and material of Laboratory of Oral Pathology, São José dos Campos Dental School. The first group consisted of cytologic material obtained from the left side of the tongue and mouth floor of 30 patients who smoked more than 20 cigarrettes/day/10years and had no history of malignant oral neoplasm or clinical signs at the site evaluated; the second group consisted of tissue samples from 21 patients with white lesions clinically classified as leukoplakia. The third group consisted of 42 tissue samples from patients diagnosed with oral squamous cell carcinoma. Patients who underwent exfoliative cytology were examined by medical history, extra and intra-oral clinical examination. The exfoliative cytology was performed using cytobrush to obtain two smears of each selected location. After performing the immunohistochemistry for anti-survivin the slides were analyzed qualitatively by light microscopy. One smear of mouth floor and tongue was stained and evaluated by the method of Papanicolaou. Statistical analysis was performed by Fisher's exact test, Mann-Whitney and X2. Survivin was positive in 100% of cytological material from the smokers, 85.7% of oral leukoplakia and 83.3% of oral squamous cell carcinoma. Fisher's exact test showed no association between the expression... (Complete abstract click electronic access below)

published_or_final_version / Public Health / Master / Master of Public Health

The purpose of this study is to investigate specific contributing factors affecting quality assurance in the diagnosis of conventional cervical smears. More than half of South- African women fail to have one cervical smear in their lifetime and +/- 50 percent of those who do have cervical smears taken, are lost to follow-up. Since cervical cancer is the most common malignancy amongst women in developing countries, the medical profession will have to endeavor to screen a higher rate of women and ensure a 100 percent quality assurance with every patient treated in order to reduce the unacceptable high incidence of cervical carcinoma. At this stage it seems like an impossible task to screen all women in South Africa, due to far-off rural areas, shortage of medical professionals and the lack of knowledge of some women of the necessity of cervical smears. Many newly qualified South-African doctors leave the country to go and work elsewhere. South Africa then in turn has to recruit doctors from other countries to staff the State hospitals and clinics. Some areas have one doctor to thousands of patients, insufficient nursing personnel and inadequate equipment. Doctors in some areas cannot cope with the volume of work and the long hours. One has to accept that the quality of the management of some patients is affected negatively. There are a number of medico-legal issues (world wide) in relation to aspects of cervical cancer prevention practices which are controversial and are of particular concern to all of those involved in cervical cancer prevention. Various countries have therefore formed different national organizations to address the medico-legal issues in screening for the prevention of cancer. These organizations monitors procedures, internal quality control as well as external quality control. In South Africa, medico-legal cases are not so prevalent, but may become so shortly. The South-African medical professionals therefore have to ensure that their quality of work conforms to accepted good practice in all circumstances. State hospitals serve thousands of patients per month and it is an every day occurrence to see long queues of patients sitting waiting for doctors and who often have to come back the following day. The situation appears to be much improved in private practice and since patients have medical cover and accessible medical facilities. Since cervical cancer is the most common malignancy amongst women in developing countries, the medical profession will have to endeavor to screen a higher rate of women and ensure a 100 percent quality assurance with every patient treated in order to reduce the unacceptable high incidence of cervical carcinoma. At this stage it seems like an impossible task to screen 100 percent of women in South Africa, due to far-off rural areas, the shortage of medical professionals and ignorance of patients. Quality assurance is therefore of paramount importance to every medical professional for every patient treated. Laboratories all worldwide have been, or are in the process of being accredited by their specific accreditation authorities. The main reason for this is improvement of quality control and therefore quality assurance. The South African National Accreditation Society (SANAS) now accredits various laboratories in South Africa with the view of accreditting all laboratories within a certain time limit. The Ampath laboratory Port Elizabeth was successfully accredited during 2001. Accredited laboratories have to uphold a very high degree of quality to remain accredited. A team of professionals inspects the laboratory every 2 years and other quality assurance staff inspects the laboratories every few months. All aspects of the laboratory are checked, e.g. the qualification of staff, their registration with the Health Professions Council of South Africa (HPCSA), their curriculum vitaes, equipment, safety of the laboratory etc. Since the laboratory chosen for this study, is accredited, the author evaluated every cervical smear that was received in the laboratory since the year 2000, with the following objectives in mind: · Whether the presence or absence of an endocervical component has an effect on the adequacy of cervical smears · To determine the effect of using smaller coverslips on quality assurance in the cytology laboratory · Evaluate the effect that manual re-screening of smears has on quality assurance in the cytology laboratory. As there is a shortage of cytotechnologists and pathologists worldwide, several countries make use of automated screening devices as primary screening or secondary screening for quality assurance. These devices were tested in some laboratories in South Africa but were found to be very expensive and sensitivity and specificity were not up to standard. Sensitivity is a measure of the ability of a test to detect the abnormal - Sensitivity is the ratio of true positives to true positives + false negatives. Specificity is a measure of the ability of a test to correctly identify the negative - Specificity is the ratio of true negative to true negatives + false positives. The automated screening machines failed to identify abnormal cells amongst inflammatory cells, as well as in very blood stained smears. Several other problems also occurred and an increasing number of smears had to be manually rescreened, thus making this exercise costly and not helpful as a quality assurance instrument. The slides used for this thesis, have been retrieved from the archives of the Ampath laboratory in Port Elizabeth. Fourteen specific contributing factors affecting quality assurance in the diagnosis of cervical smears are also discussed and conclusions and recommendations given.

Yuan, Qin. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (leaves 112-119). / Abstracts in English and Chinese. / Acknowledgements --- p.III / Publications --- p.V / List of Abbreviations --- p.VI / List of Figures --- p.VII / List of Tables --- p.VIII / Abstract in English --- p.IX / Abstract in Chinese --- p.XII / Table of Contents --- p.XIII / Chapter CHAPTER1 I --- NTRODUCTION --- p.1 / Chapter 1.1 --- What is telemedicine --- p.1 / Chapter 1.2 --- What is telepathology --- p.4 / Chapter 1.2.1 --- Types of telepathology system --- p.7 / Chapter 1.2.2 --- Main events in the development of telepathology --- p.9 / Chapter 1.2.3 --- Diagnostic accuracy in telepathology and telecytology --- p.12 / Chapter 1.2.4 --- Applications of telepathology --- p.18 / Chapter 1.2.4.a --- Remote primary diagnosis --- p.18 / Chapter 1.2.4.b --- Remote expert consultation --- p.19 / Chapter 1.2.4.c --- "Image libraries, databases and archiving" --- p.20 / Chapter 1.2.4.d --- Quality assurance --- p.20 / Chapter 1.2.4.e --- Remote teaching and training --- p.21 / Chapter 1.3 --- Technical aspects of telepathology --- p.24 / Chapter 1.3.1 --- Image presentation --- p.24 / Chapter 1.3.2 --- Image acquisition and display --- p.25 / Chapter 1.3.3 --- Image compression --- p.27 / Chapter 1.3.4 --- Networking and line connections --- p.29 / Chapter 1.3.4.a --- Public (analog) telephone network --- p.29 / Chapter 1.3.4.b --- Integrated services digital network (ISDN) --- p.30 / Chapter 1.3.4.c --- Computer network --- p.30 / Chapter 1.3.4.d --- Asynchronous transfer mode (ATM) --- p.31 / Chapter 1.4 --- Legal and ethical aspects --- p.32 / Chapter 1.4.1 --- Licensure of the facility --- p.33 / Chapter 1.4.2 --- Licensure of the pathologist --- p.33 / Chapter 1.4.3 --- Accreditation --- p.34 / Chapter 1.4.4 --- The electronic medical record: privacy --- p.35 / Chapter 1.4.5 --- Malpractice liability --- p.36 / Chapter 1.4.6 --- Reimbursement --- p.38 / Chapter 1.4.7 --- Conclusion --- p.38 / Chapter 1.5 --- Telemedicine and telepathology in China --- p.40 / Chapter 1.6 --- Cytopathology practice in China --- p.42 / Chapter CHAPTER2 --- OBJECTIVES OF STUDY --- p.46 / Chapter CHAPTER3 --- MATERIALS AND METHODS --- p.48 / Chapter 3.1 --- Case materials --- p.48 / Chapter 3.2 --- Static image capture and display --- p.51 / Chapter 3.3 --- Static telecytology study --- p.55 / Chapter 3.4 --- Web-based tutorial program --- p.59 / Chapter 3.4.1 --- Pre-tutorial evaluation --- p.60 / Chapter 3.4.2 --- Cytology tutorial --- p.62 / Chapter 3.4.3 --- Post-tutorial evaluation --- p.66 / Chapter 3.4.4 --- Data analysis --- p.67 / Chapter 3.5 --- Dynamic telecytology study --- p.68 / Chapter 3.5.1 --- Equipment --- p.68 / Chapter 3.5.2 --- Trial design --- p.72 / Chapter 3.5.2a --- Telecytology diagnosis --- p.72 / Chapter 3.5.2b --- Light microscopy diagnosis --- p.73 / Chapter 3.5.2c --- Data analysis --- p.74 / Chapter CHAPTER4 --- RESULTS --- p.75 / Chapter 4.1 --- General information about participating cytology laboratories --- p.75 / Chapter 4.2 --- Static telecytology study --- p.78 / Chapter 4.2.1 --- Telecytology diagnostic agreement --- p.78 / Chapter 4.2.2 --- Confidence of telecytology diagnosis --- p.80 / Chapter 4.2.3 --- "The acceptance of the image quality, time required for each case" --- p.83 / Chapter 4.3 --- Web-based program on cervical cytology --- p.84 / Chapter 4.4 --- Dynamic telecytology study --- p.86 / Chapter 4.4.1 --- Diagnostic accuracy --- p.86 / Chapter 4.4.2 --- Time studies --- p.88 / Chapter 4.4.3 --- Diagnostic certainty --- p.89 / Chapter 4.4.4 --- Image quality --- p.91 / Chapter CHAPTER5 --- DISCUSSION --- p.92 / Chapter 5.1 --- Static image telecytology study linking 14 Mainland China hospitals --- p.93 / Chapter 5.2 --- Problems encountered in setting up links with Mainland China --- p.97 / Chapter 5.3 --- Web-based tutorial programme for remote teaching --- p.100 / Chapter 5.4 --- Dynamic image telecytology study for immediate diagnosis at a distance --- p.103 / Chapter 5.5 --- Limitations of this study --- p.105 / Chapter 5.6 --- Concluding remarks --- p.108 / REFERENCES --- p.112

Este estudo propôs-se a avaliar lesões de lábio inferior de pescadores nas praias de Florianópolis, Santa Catarina, Brasil, através de análise clínica, cito e anatomopatológica. Foi realizada análise citológica de esfregaços do lábio inferior de todos os pescadores (125) cuja celularidade foi adequada (83,2% dos casos). Em 16 pescadores a avaliação clínica indicou a necessidade de biópsia, nos quais observaram-se 4 casos de lesão maligna (3,2%) e 12 de graus variados de displasia (9,6%). A análise citológica dos esfregaços não foi capaz de detectar nenhuma das alterações displásicas ou malignas diagnosticadas nas biópsias. Todos os casos em que as características clínicas indicaram a necessidade de biópsia revelaram alterações significativas na análise histopatológica. Concluiu-se que a incidência de lesões displásicas e malignas é alta na população de pescadores estudada e que está fortemente associada às manifestações clínicas correspondentes à alteração na delimitação entre vermelhão do lábio e pele e aumento da consistência à palpação, não sendo a citologia esfoliativa adequada, apenas em bases morfológicas, para avaliação de queilite actínica e câncer de lábio. / This study proposed to evaluate the injury of lower lip of fishermen on the beaches of Florianópolis, Santa Catarina, Brazil, through clinical, cytopathological and histopathological analysis. Cytological examination was performed on smears of the lower lip of all fishermen (125) whose cellularity was satisfactory in 83,2% of the cases. On 16 fishermen the clinical evaluation indicated the need of biopsy. In 4 cases (3.2%) it was observed malignant lesions and in 12 cases (9,6%) it was observed differents degrees of dysplasia. The cytological analysis was unable to detect any of the dysplastic changes or malignancies diagnosticated in the histopathological study. In all cases where the clinical features indicated the need of biopsy it had significant changes in microscopic analysis. It was concluded that the incidence of malignant and premalignant lesions is high in this fishermen studied population, which is strongly associated with the clinical manifestations corresponding to blurring of vermilion margin and infiltration, and the exfoliative cytology is inadequate, only in morphological basis, to detect dysplastic alterations and cancer of the lip.

Este estudo propôs-se a avaliar lesões de lábio inferior de pescadores nas praias de Florianópolis, Santa Catarina, Brasil, através de análise clínica, cito e anatomopatológica. Foi realizada análise citológica de esfregaços do lábio inferior de todos os pescadores (125) cuja celularidade foi adequada (83,2% dos casos). Em 16 pescadores a avaliação clínica indicou a necessidade de biópsia, nos quais observaram-se 4 casos de lesão maligna (3,2%) e 12 de graus variados de displasia (9,6%). A análise citológica dos esfregaços não foi capaz de detectar nenhuma das alterações displásicas ou malignas diagnosticadas nas biópsias. Todos os casos em que as características clínicas indicaram a necessidade de biópsia revelaram alterações significativas na análise histopatológica. Concluiu-se que a incidência de lesões displásicas e malignas é alta na população de pescadores estudada e que está fortemente associada às manifestações clínicas correspondentes à alteração na delimitação entre vermelhão do lábio e pele e aumento da consistência à palpação, não sendo a citologia esfoliativa adequada, apenas em bases morfológicas, para avaliação de queilite actínica e câncer de lábio. / This study proposed to evaluate the injury of lower lip of fishermen on the beaches of Florianópolis, Santa Catarina, Brazil, through clinical, cytopathological and histopathological analysis. Cytological examination was performed on smears of the lower lip of all fishermen (125) whose cellularity was satisfactory in 83,2% of the cases. On 16 fishermen the clinical evaluation indicated the need of biopsy. In 4 cases (3.2%) it was observed malignant lesions and in 12 cases (9,6%) it was observed differents degrees of dysplasia. The cytological analysis was unable to detect any of the dysplastic changes or malignancies diagnosticated in the histopathological study. In all cases where the clinical features indicated the need of biopsy it had significant changes in microscopic analysis. It was concluded that the incidence of malignant and premalignant lesions is high in this fishermen studied population, which is strongly associated with the clinical manifestations corresponding to blurring of vermilion margin and infiltration, and the exfoliative cytology is inadequate, only in morphological basis, to detect dysplastic alterations and cancer of the lip.

Introduction: The Central Nervous System (CNS) is an important site of relapse in patients with Acute Lymphoblastic Leukemia (ALL), despite increasing cure rates in the last four decades in young patients. The presence of leukemic blasts in the Cerebrospinal Fluid (CSF) presents prognostic implication and therefore defines changes in the therapeutic protocol, which is why it requires diagnostic accuracy. The emergence of new techniques for identifying CSF leukemia blasts, such as flow cytometry and molecular methods, which are more costly and not uniformly accessible for clinical use, have led to the need to reassess the role of conventional cytology as diagnostic tool. Objectives: To identify the proportion of CSF samples positive for blasts in children and adolescents with ALL, using a standardized cytology technique and with standardization of variables related to the process that could interfere with the result. DESIGN: Prospective, descriptive, uncontrolled study in which samples of CSF obtained by lumbar puncture of patients with ALL that were starting treatment were examined. CSF samples were sent to the laboratory shortly after collection, being processed and cytocentrifugated in cytofunyl in up to four hours after collection. Four slides were prepared, stained and analyzed by a pathologist and a hematologist. RESULTS: Twenty-eight patients with ALL were evaluated, with predominance of male (58.6%), immunophenotype B (82.2%) and 78.5% were stratified as high risk for relapse. Of the 205 CSF samples evaluated, 26 (12.6%) were positive for blasts and among 28 patients, 11 (39.2%) had CSF with neoplastic infiltration. Comparing the groups with and without CNS infiltration, no statistically significant difference was observed for the variables analyzed. CONCLUSIONS: Conventional cytology was effective in the identification of CNS infiltration by blasts, provided there is a vigilance of factors related to collection, processing and analysis of CSF that may interfere in the reliability of the result. / Introdução: O Sistema Nervoso Central (SNC) é importante sítio de recaída em pacientes com Leucemia Linfoblástica Aguda (LLA), apesar das crescentes taxas de cura nas últimas quatro décadas em pacientes jovens. A presença de blastos leucêmicos no Líquido Cefalorraquiano (LCR) apresenta implicação prognóstica e, portanto, define mudanças no protocolo terapêutico, razão pela qual requer acurácia diagnóstica. O surgimento de novas técnicas de identificação de blastos leucêmicos no LCR, como a citometria de fluxo e os métodos moleculares, que têm custo mais elevado e não estão uniformemente acessíveis para uso clínico, trouxe a necessidade de reavaliar-se o papel da citologia convencional como instrumento diagnóstico. Objetivos: Identificar a proporção de exames de LCR positivos para blastos em crianças e adolescentes com LLA, utilizando-se de técnica de citologia padronizada e com padronização de variáveis relacionadas ao processo que pudessem interferir no resultado. Delineamento: Estudo prospectivo, descritivo, não controlado, no qual foram examinadas amostras de LCR obtidas por punção lombar de pacientes com LLA que estavam iniciando o tratamento. As amostras de LCR foram encaminhadas ao laboratório logo após a coleta, sendo processadas e citocentrifugadas em citofunil em até no máximo quatro horas após a coleta. Quatro lâminas foram preparadas, coradas e analisadas por um patologista e um hematologista. Resultados: Foram avaliados 28 pacientes com LLA, havendo predomínio do sexo masculino (58,6%), imunofenótipo B (82,2%) e 78,5% foram estratificados como de alto risco para recaída. Dentre as 205 amostras de LCR avaliadas, 26 (12,6%) foram positivas para blastos e dentre os 28 pacientes, 11 (39,2%) obtiveram algum exame de LCR com infiltração neoplásica. Comparando-se os grupos com e sem infiltração de SNC, não se observou diferença estatisticamente significante para as variáveis analisadas. Conclusão: Citologia convencional foi efetiva na identificação de infiltração de SNC por blastos leucêmicos, desde que haja vigilância dos fatores relacionados a coleta, processamento e análise do LCR que possam interferir na fidedignidade do resultado. / Aracaju, SE

The study is informed by inadequate information on factors associated with the prevalence, incidence and mortality of cervical cancer cytological abnormalities in Swaziland. The aim of the study was to explore and describe factors associated with cervical cancer among women of reproductive age between 15 and 49 years in Swaziland. Quantitative descriptive design with a data extraction tool was used to retrospectively generate observational data from 1748 patients’ records in Mbabane Government Hospital from January 2014 through to December 2014. Bivariate logistic regression was used to establish relationship between cervical cancer and each explanatory variable. The overall prevalence of cervical cytology test results was 24.9%. The combination of marital status, HIV status, ART status, age at sexual debut have been identified as factors associated with cervical abnormalities. Most importantly, the results will also serve as evidence for the development of a national cervical cancer screening policy and also strengthening the cancer registry in Swaziland. / Health Studies / M.A. (Public Health)

Optical microscopy is the simplest and the gold standard method adopted for the screening and subsequent diagnosis of various hematological and infectious diseases like malaria, sickle cell disease, tuberculosis etc. In addition to infectious disease diagnosis, its applications range from routine blood tests to the more sophisticated cancer biopsy sample analysis. Microscopy Tests (MTs) follow a common procedural workflow: (1) A technician prepares a smear of the given sample on a glass slide in a specific manner depending on the sample and the disease to be diagnosed; (2) The smeared slide is subsequently exposed to fixative agents and different histochemical stains specific to the diagnosis to be performed and (3) the prepared slide is then observed under a high quality bright- field bench-top microscope. An expert pathologist/cytologist is required to manually examine multiple fields-of-views of the prepared slide under appropriate magnification. Multiple re-adjustments in the focus and magnification makes the process of microscopic examination time consuming and tedious. Further, the manual intervention required in all the aforementioned steps involved in a typical MT, makes it inaccessible to rural/resource limited conditions and restricts the diagnostics to be performed by trained personnel in laboratory settings. To overcome these limitations, there has been considerable research interest in developing cost-effective systems that help in automating MTs. The work done in this thesis addresses these issues and proposes a two-step solution to the problem of affordable automation of MTs for cellular imaging and subsequent diagnostic assessment. The first step deals with the development of a low cost portable system that employs custom-built microscopy setup using o -the-shelf optical components, low cost motorized stage and camera modules to facilitate slide scanning and digital image acquisition. It incorporates a novel computational approach to generate good quality in-focus images, without the need for employing high-end precision translational stages, thereby reducing the overall system cost. The process of slide analysis for result generation is further automated by using image analysis and classification algorithms. The application of the developed platform in automating slide based quantitative detection of malaria is reported in this thesis. The second aspect of the thesis addresses the automation of slide preparation. A major factor that could influence the analysis results is the quality of the prepared smears. The feasibility of automating and standardizing the process of slide preparation using Microfluidics with appropriate surface fictionalization is explored and is demonstrated in the context of automated semen analysis. As an alternative to the mechanism of fixing the spermatozoa to the glass slide by smearing and chemical treatment with fixative, microfluidic chips pre-coated with adhesive protein are employed to capture and immobilize the cells. The subsequent histochemical staining is achieved by pumping the stains through the microfluidic device. The proof-of-principle experiments performed in this thesis demonstrate the feasibility of the developed system to provide an end-to-end cost-effective alternative solution to conventional MTs. This can further serve as an assistive tool for the pathologist or in some cases completely eliminate the manual intervention required in MTs enabling repeatability and reliability in diagnosis for clinical decision making

OBJETIVO: O objetivo deste estudo foi analisar a concordância entre o esfregaço anal e a biópsia guiada por anuscopia de alta resolução no diagnóstico da displasia anal em pacientes infectados pelo HIV. MÉTODO: Conduzimos uma análise transversal de pacientes infectados pelo HIV submetidos a rastreamento de displasia anal rotineiro. A concordância entre mensurações foi estimada por índice de kappa ponderado através de sistema de avaliação citológica e histológica de três categorias (normal, displasia de baixo grau, e displasia de alto grau). Estimativas de sensibilidade, especificidade e valores preditivos foram calculados através de sistema de avaliação citológica e histológica de duas categorias (ausência de displasia e displasia de qualquer grau). Estimativas foram calculadas também para a detecção de displasia de alto grau. RESULTADOS: No decorrer de um ano, 222 pacientes foram submetidos a 330 esfregaços anais seguidos de biópsias guiadas por anuscopia de alta resolução. Trezentos e onze (311) esfregaços com biópsias concomitantes foram satisfatórios. Considerando-se a histologia como padrão, a freqüência de displasia anal foi de 46%. O índice kappa ponderado para concordância entre o esfregaço anal e a biópsia foi de 0,20. Para detecção de displasia anal de qualquer grau, o esfregaço anal demonstrou sensibilidade de 61%, especificidade de 60%, valor preditivo positivo de 56% e valor preditivo negativo de 64%. Para displasia de alto grau, o esfregaço anal demonstrou sensibilidade de 16% e especificidade de 97%. CONCLUSÃO: Os resultados obtidos no presente estudo, em que comparamos os achados da citologia dos esfregaços com os achados histológicos das biópsias dirigidas pela anuscopia de alta resolução em pacientes infectados pelo HIV permitiram concluir que houve baixa concordância entre eles / Purpose: To analyze the agreement between anal Pap smear and high resolution anoscopy guided biopsy to diagnose anal dysplasia in HIV-infected patients. Methods: Cross sectional analysis of HIV-infected patients receiving anal dysplasia screening as part of routine care. Agreement between measures was estimated by weighted kappa-statistics, using 3-tiered cytologic and histologic grading system (normal, low grade dysplasia, and high grade dysplasia). Estimates of sensitivity, specificity, and predictive values were calculated using a 2-tiered cytologic and histologic grading system (without dysplasia, and with dysplasia of any grade). Estimates were also calculated for the detection of high grade dysplasia. Results: Two hundred and twenty-two patients underwent 330 anal Pap smears followed by high resolution anoscopy guided biopsies in one year period. There were 311 satisfactory Pap smears with concurrent biopsy. Considering histology the standard, the frequency of anal dysplasia was 46 percent (95 percent confidence interval: 40-51 percent). Kappa-agreement between anal Pap smear and biopsy was 0.20 (95 percent confidence interval: 0.10 0.29). Anal Pap smear showed sensitivity of 61 percent, specificity of 60 percent, positive predictive value of 56 percent, and negative predictive value of 64 percent for detection of anal dysplasia of any grade. For high grade dysplasia, anal Pap smear showed sensitivity of 16 percent, and specificity of 97 percent. Conclusion: The present study showed a low concordance between anal Pap smears and high resolution anoscopy-guided biopsy