Perfil de pacientes com lesão intraepitelial escamosa de baixo (LSIL) e de alto grau (HSIL) no colo uterino a partir de correlação da citologia em meio líquido com identificação de genótipos de HPV e histopatologia

Abstract

Cervical cancer is the fourth most common type of cancer in women and the most common gynecological malignancy. It has great healing potential when diagnosed and treated early, hence the importance of screening tests for the HPV virus. The objective of the study was to evaluate a possible association between the cytological findings of low-grade (LSIL) and high-grade (HSIL) squamous intraepithelial lesions with their respective histopathological results and HPV genotypes. This is a cross-sectional, quantitative and observational research with samples from cervico-vaginal collections in liquid medium acquired in private clinics in the city of Fortaleza from January 2010 to December 2023. During the research, samples were excluded collected from pregnant women, users of immunosuppressive medications and patients with a disease that leads to reduced immunological competence. 4411 cervicalvaginal samples were collected, divided into low-grade squamous intraepithelial lesion (LSIL) (n = 4141) and high-grade intraepithelial lesion (HSIL) (n = 259), with 11 samples excluded. The socio-behavioral characteristics of the patients, the contraceptive methods used, the main complaint reported during the consultation, the vaginal microbiota and the cytopathological aspects of the samples, the HPV genotypes found in the molecular tests and the histopathological result when performed were evaluated. Fisher's test and Studart's t-test or Mann-Whitney test were used, and the level of statistical significance was set at p <0.05. The average age of patients with LSIL was 31.38 years and 0.74 pregnancies, while patients with HSIL had an average of 37.18 years and 1.83 pregnancies. The visit to the gynecologist for a routine consultation, the use of oral contraceptives and the presence of both Gardnerella sp. such as Candida sp. in the vaginal microbiota were the main results found in both lesions. Koilocytosis (65.83%) and binucleation (97.67%) were the main cytopathological features found in low-grade lesions and dyskaryosis (52.5%) in high-grade lesions. Isolated HPV 16 and associated HPV 31 were the most common genotypes found in molecular tests in both lesions. In biopsies, CIN 1 was the main histopathological result in low-grade lesions (54.14%) and CIN3 in high-grade lesions (82.82%).