Cervicografia digital uterina: validação da técnica e dos critérios de positividade

Abstract

In the whole world, the second most carmmon type of câncer among women is the uterin collum câncer, and the main method used to detect it is still the Papanocolaou test. The main objective of this study was to validate the digital cervicography (DC) as a complementary test to the Papanicolaou citology (Pap), in the primary attention levei, verifying if the positivity objectives of criteria proposed for the study improve the screening sensibility of the uterin collum câncer and its precurso lesions. Digital camaras of the amateur and semi-profissional segment were used, easy-to-use and low-cost equipments. For this purpose an evaluation research of quantitative character was done in a public municipal health center in Fortaleza. The population of this study was 1.286 women and the sample was 300 cases of visual inspection with acetic-acid at 5% (VIA) positive. The women were between 18 to 70 years old, médium age of 27,6 years old, and were submitted to VIA, Pap, DC and colposcopy. All the citologic collections, DC and VIA test where done by nurses. When necessary, the histopatologic exam as gold pattern was used. The digital cervicograph were analyzed by two professionals and classified as positive, before and after an application of acetic acid at 5%. The first evaluation and classification were done by a gynecologist doctor analysing the cervicograms according to colposcopic criteria and the professional’s clinic experience. The second evaluation and classification were done by the investigator according to the positivity criteria proposed by the investigation. None of the profissionais previously knew about the results of the cytologic exams. 189 women were submitted to the colposcopy and 139 biopsies (46,3%) were done. The sensibility and specificity of the exams were determined by diagnostic tests with Cl 95%. The test sensibility of the VIA, the DC and the Pap was 99,1%, 99,1% and 22,5%, respectively. The specificity found for these tests was 83,9% for the VIA test, 81,3% for the DC, and 100,0% for the Pap. The Papanicolaou cytology didn’t detect any case of câncer selected by the VIA or the DC. It is concluded that the DC besides being a low - cost, easy-to-do and easy-to-interpret test, it has high sensibility sufficient to justify its adaption in order to complement the Pap. The DC increased 4.5 times the tracking efficacy for the intra-epitelial cervic neploasies and uterin collum câncer if compared to the results obtained in the Pap, in an isolated way. The prevalence tax of the uterin collum câncer and of the intra-epitelial neoplasies in the population studied was: in the low levei intra-epitelial lesions = 7,6% (99/1.286); in the high levei intra-epitelial lesions = 0,38% 5/1.286); and in câncer = 0,23% (3/1.286). It is also concluded that because it permits the racionalization of the colposcopic exam and the improvement of the tracking quality, it can become an important instrument in the reduction of the morbidity and mortality by uterin collum câncer.