Historial de cribado oportunista mediante citología cervical en 277 casos de carcinoma escamoso in situ/invasivo de cérvix

Castro, P.; Marcos, R.; López, E.; Sabriá, J.; Izquierdo, A.; Barceló, C.

doi:10.1016/S0304-5013(04)75992-0

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Resumen

Objetivo

Análisis del historial de cribado oportunista en 277 casos de carcinoma escamoso de cérvix (in situ = 221, invasivo = 56).

Material y métodos

Criterios de inclusión: diagnóstico histológico de carcinoma y una citología cervical hasta 5 años antes. Se utiliza la terminología “The 2001 Bethesda System”.

Resultados

La proporción de carcinoma in situ/invasivo es 4:1 (10:1 en 2002). La media de edad es 42,7 años (17-84): in situ, 40,3 (17-84); microinvasivo, 45,6 (30-68); invasivo, 53,4 (31-84); (F = 24,3; p < 0,0001). Hay 1,8 citologías por caso (rango, 1-6). La mediana del intervalo de diagnostico es 1 mes (rango, 1-66). La citología previa al diagnóstico es positiva en un 78,8%; LSIL (low grade squamous intraepithelial lesion), 10,7%; ASC-H (atipical squamous cells cannot exclude HSIL), 5,9%; ASC-US (atipical squamous cells of undetermined significance), 1,9%, y negativa, 0,8%. La citología (5 años previos) es positiva en un 43,6%, LSIL 16,6%, ASC-H 3,8%, ASCUS 14,2% y negativa 21,8%. En la revisión, la citología negativa (109), sigue siendo negativa en un 56,8%, es inadecuada para el 33,9% y es positiva para el 9,1%.

Conclusiones

El estudio sugiere la necesidad de un cribado organizado.

Palabras clave:

Cribado

Citología

Cáncer de cérvix

Abstract

Objective

To analyze the histories of opportunistic screening in 277 cases of cervical squamous carcinoma (in situ = 221, invasive = 56).

Material and methods

Inclusion criteria consisted of biopsy-proven diagnosis and cytology up to 5 years previously. The cytology results were expressed according to “The 2001 Bethesda System”.

Results

The ratio in situ/invasive carcinoma was 4:1 (10:1 in 2002). The mean age was 42.7 years (17-84): in situ, 40.3 (17-84); microinvasive, 45.6 (30-68); invasive, 53.4 (31-84); (F=24.3; P<.0001). There were 1.8 (range: 1-6) cytology smears per case. The median diagnostic interval was 1 month (range: 1-66). Cytology prior to diagnosis was positive in 78.8%, low-grade squamous intraepithelial lesion (LSIL) in 10.7%, atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H) in 5.9%, ASC of undetermined significance (ASC-US) in 1.9% and was negative in 0.8%. Cytology (in the 5 previous years) was positive in 43.6%, LSIL in 16.6%, ASC-H in 3.8%, ASC-US in 14.2% and was negative in 21.8%. After review of 109 negative smears, 56.8% remained negative, 33.9% were inadequate and 9.1% were positive.

Conclusions

The results of this study strongly suggest the need for organized screening.

Keywords:

Screening

Cytology

Cervical cancer

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