Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A infecÃÃo pelo Papilomavirus humano à a principal causa do carcinoma de colo uterino. No Cearà o cÃncer cervical à o segundo mais freqÃente entre as mulheres, quando se excetua o cÃncer de pele. à uma doenÃa de fÃcil prevenÃÃo, haja vista que quando se dispÃe de um serviÃo bem estruturado a mortalidade à reduzida em atà 80% dos casos. O problema à que muitas mulheres nÃo tÃm acesso a testes de varredura, cujos motivos estÃo relacionados a diversas barreiras culturais e geogrÃficas, bem como a baixa oferta e/ou inexistÃncia de serviÃos. O Cearà conta com cerca de 10.000 agentes comunitÃrios de saÃde, o que representa uma possibilidade de se levar um teste de autocoleta atà estas mulheres, considerando, todavia, que este teste tivesse uma sensibilidade e especificidade aceitÃvel e, assim, atendendo rapidamente um quantitativo significativo de mulheres que nunca fizeram o exame de prevenÃÃo ou estÃo em intervalo recomendado para repeti-lo. Em face ao exposto, este estudo tem por objetivo comparar a sensibilidade e especificidade da Captura HÃbrida de espÃcime cÃrvico-vaginal para HPV-DNA por autocoleta domiciliar em condiÃÃes reais, com a Captura HÃbrida para HPV-DNA coletado por mÃdico ginecologista em consultÃrio e nas condiÃÃes ideais. Os dados foram coletados no perÃodo de agosto a dezembro de 2002, junto a 878 mulheres de cinco cidades cearenses. Estas foram submetidas, na mesma semana, aos testes de Captura HÃbrida por autocoleta, citologia, Captura HÃbrida coletada pelo mÃdico ginecologista, colposcopia e histopatolÃgico, quando necessÃrio. Das 878 mulheres participantes 815 foram consideradas negativas pelo padrÃo ouro, 54 foram consideradas positivas - baixo grau e 9 foram consideradas alto grau - carcinoma. Nos resultados das amostras para Captura HÃbrida HPV-DNA da autocoleta e da coleta mÃdica, obtiveram-se que em 546 casos, ambos os testes concordaram como negativos, em 216 casos concordaram como positivos, em 35 casos houve discordÃncia com a coleta mÃdica positiva e em 81 casos houve discordÃncia com a autocoleta positiva. Os percentuais de sensibilidade encontrados da citologia, Captura HÃbrida por coleta mÃdica e Captura HÃbrida autocoleta foram, respectivamente, 18,3%, 63,3% e 66,7%. Os percentuais de especificidade verificados da citologia Captura HÃbrida coleta mÃdica e Captura HÃbrida autocoleta foram, respectivamente, 98,0%, 73,0% e 68,7%. Comparando-se a concordÃncia entre ambas as coletas de Captura HÃbrida, obteve-se o coeficiente de Kappa (K=0,693) com um erro padrÃo de 0,026 embora existe diferenÃa significativa da prevalÃncia detectada por ambos os testes, teste de McNemar (p<0,001). Avaliando-se as Ãreas da curva ROC para ambos os testes, mostrou-se coleta mÃdica Ãrea=0,738 com coeficiente de 95% de certeza - o intervalo de confianÃa IC=[0,673;0,802] e autocoleta Ãrea= 0,670 com 95% de certeza - o intervalo de confianÃa IC=[0,597;0,742] para detecÃÃo do Papilomavirus. Concluiu-se haver boa concordÃncia entre os resultados obtidos pela autocoleta de espÃcime para realizaÃÃo da Captura HÃbrida HPV-DNA com a coleta mÃdica. / Human Papillomavirus infection is the mean cause of the most of cervical cancers. In Cearà this type of cancer is the second in frequency among the women, when the skin cancers are excluded. Cervical cancer is one the most preventable. Where well structured programs exist the mortality has declined, and in some cases in about 80% .The mean problem is that cervical cancer screening is not fully utilized among groups of women, especially those without access or because there are no services offered or when services exist there are many other barriers, since cultural aspects to geographic barriers. In Cearà exist well structured Health communitarian agents program, which we estimate in about 10.000 agents that cover fully the necessities of population in their areas and the all Cearà territory. With this program we can carry on one screening program by self-sampling if this test were acceptable and had a good sensitivity and specificity. By these communitarian agents we could insert in screening program all women who never underwent to pap smear or other type of screening test. The mean objective of this work is to determine whether testing of self-collected vaginal specimen for Human Papillomavirus has the same accuracy of sampling collected by physicians . In order to evaluate this one Cross-sectional observational study was done between August and December of 2002, 878 women from five municipalities were enrolled and the tests were done in the same week, the women started by doing self-sampling at home and after that they were undergone in physicianâs clinics to the others examination in following sequence cytology, hybrid capture HPV-DNA, colposcopy and when were necessary biopsy. OF 878 women that participated in this study , 815 were considered negative by the gold standard ,54 were considered positive low grade and 9 were high grade/ carcinoma . Of 878 samples to HPV-DNA , there was negative concordance to both test in 546 samples, there was positive concordance in 216 samples, there was discordance in 35 samples where the physician collect were positive and finally there was discordance in 81 samples where the self-collect were positive. The results of sensitivity to cytology, Hybrid Capture by physicians, Hybrid Capture by self-sampling were, respectively 18%, 63,3% and 66,7%. The prevalence estimated by the gold standard were 7,2% in this sample. The results of specificity to cytology, hybrid capture by physicians, hybrid capture by self-sampling were, respectively 98%, 73% and 68,7%. There was significant difference between the results of HPV-DNA self-collected and collected by the physicians, McNemar test p<0,001. When we compare the concordance through the Kappa index we have obtained k=0,693 with stand error of 0,026. Compared the areas obtained by the ROC curve as follows area=0,738 that represent the achievement of physician collected with IC=[0,673;0,802] with 95% confidence interval to detect HPV in sample, area=0,670 that represent the achievement of self-collected sample to HPV with the 95% of confidence interval IC=[0,597;0,742].We concluded that Hybrid Capture by self-collected vaginal sample is as good as Hybrid Capture collected by the physicians, and there was good concordance between these tests.
| Identifer | oai:union.ndltd.org:IBICT/oai:www.teses.ufc.br:65 |
| Date | 04 April 2005 |
| Creators | Francisco Holanda JÃnior |
| Contributors | Francisco Manuelito Lima de Almeida, Luiz Gonzaga Porto Pinheiro, Gerson Botacini das Dores |
| Publisher | Universidade Federal do CearÃ, Programa de PÃs-GraduaÃÃo em Tocoginecologia, UFC, BR |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da UFC, instname:Universidade Federal do Ceará, instacron:UFC |
| Rights | info:eu-repo/semantics/openAccess |
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