RESUMO
BACKGROUND: The causal relationship between high-risk (hr) HPV infection and precancerous lesions or cervical cancer has led to the development of strategies to increase screening performance and prevent this cancer. The increased sensitivity of DNA-HPV testing compared to cervical cytology favors DNA-HPV testing as a primary screening test. Cervical cancer screening in Brazil is opportunistic, and this cancer remains a considerable health problem with a high proportion of diagnoses in advanced stages. This paper aims to describe the design and implementation of the Cervical Cancer Screening Program with primary DNA-HPV testing (CCSP-HPV) planned for Indaiatuba City (SP), Brazil; the strategies to achieve higher population coverage; and a study protocol for cost-effectiveness analyses. METHODS: The CCSP-HPV was designed based on successful guidelines that replaced cervical cytology-based screening by the DNA-HPV test performed at 5-year intervals. The screening will be performed for the female population aged 25-64 years cared for by the public health system and aim to reach 80% coverage after completing the first round. The chosen DNA-HPV test detects 14 hr-HPV types and genotypes HPV-16 and 18. All women with a negative test will be reassessed after five years. Women showing a positive test for HPV-16 and/or 18 will be referred for colposcopy. Those showing the other 12 hr-HPV types will be tested by cytology, and if any abnormality is detected, they will also be referred for colposcopy. The histopathologic evaluation will be reviewed by a pathologist panel and aided by p16 immunohistochemistry. A cost-effectiveness analysis will be performed by a Markov model comparing the cost of the new program and the screening performed by conventional cytology five years prior (2011-2016). DISCUSSION: The new screening program is considered a breakthrough for public health regarding cervical cancer, which is the third leading cause of cancer death among Brazilian women. Achieving at least 80% coverage will have the possibility to change this scenario. The proposed program will provide a modern cervical cancer screening method for women, and information about cost-effectiveness will help other similar places support the decision of implementing cervical cancer screening using the DNA-HPV test.
Assuntos
DNA Viral/análise , Detecção Precoce de Câncer/economia , Infecções por Papillomavirus/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adulto , Brasil , Colposcopia/economia , Análise Custo-Benefício , Citodiagnóstico/economia , Detecção Precoce de Câncer/métodos , Feminino , Papillomavirus Humano 16/genética , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/economia , Infecções por Papillomavirus/virologia , Gravidez , Neoplasias do Colo do Útero/economia , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal/economiaRESUMO
BACKGROUND: Rapid on-site evaluation is a great tool for optimizing the adequacy and quality of cytologic samples. The objective of the current study was to analyze a low-cost telecytopathology method for the remote assessment of thyroid fine-needle aspiration biopsies (FNABs), with comparison of the primarily rendered adequacy and diagnosis with the final conventional analysis. METHODS: Material collected from thyroid FNABs was immediately smeared onto glass slides and stained with Diff-Quik. A conventional microscope attached to a smart device was operated on-site by either a medical student or a pathology resident for Wi-Fi transmission of the images by Skype. The cytopathologist would remotely guide the screening of the slides, zooming in and out of areas of interest. Remote assessment included an analysis of material adequacy and a preliminary diagnosis. The quality of the transmission and the number of slides also were recorded. After a washout period of 3 weeks, final diagnosis and adequacy were assigned by conventional microscopy. RESULTS: The final agreement rate for adequacy between remote and conventional analysis was 90.5%. For diagnosis, the final agreement rate was 83.3%. The diagnosis agreement rate varied, depending on the quality of transmission: there was 88% agreement when the quality was excellent, 77.8% agreement when it was good, and 62.5% agreement when it was poor. CONCLUSIONS: Low-cost telecytopathology is an efficient method for the remote assessment of thyroid FNAB adequacy and diagnosis. The wide use of such technology in low-resource or remote centers may have a positive impact on the number of adequate or satisfactory samples, optimizing the management of patients who have thyroid nodules.
Assuntos
Citodiagnóstico/economia , Citodiagnóstico/métodos , Telepatologia/economia , Telepatologia/métodos , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/economia , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Citodiagnóstico/instrumentação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Telepatologia/instrumentação , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/economiaRESUMO
OBJECTIVE: To test the performance of a new fixative for pap smear collection for liquid-based cervical cytology, CellPreserv® and compare it with the commercially available, PreservCyt® used in the diagnosis and detection of human papillomavirus (HPV). METHODS: Seven hundred twenty five women participated in this study after signing an informed consent. The specimens were collected using a traditional device, agitated in PBS, and equally divided in both fixatives. The slides were prepared routinely, stained by Papanicolaou, examined blindly by 2 cytologists, and reviewed by one cytopathologist. To search for HPV, 1,000 µL from each fixative was taken and processed by polymerase chain reaction. RESULTS: Considering the adequacy of samples, both fixatives had similar results - 0.33 and 0.32% of the cases unsatisfactory for PreservCyt® and CellPreserv®, respectively. Considering the 701 satisfactory cases and comparing the new fixative to the traditional fixative, there was 99.3% concordance between both. The results regarding the HPV detection was 100% concordant between the 2 fixatives. CONCLUSION: The new methanol-based fixative, CellPreserv®, is cheaper and equally efficient for treating cervical cancer screening and for HPV detection, and can be safely used by the health system prevailing in low-income countries.
Assuntos
Citodiagnóstico/métodos , Fixadores , Testes de DNA para Papilomavírus Humano , Metanol , Infecções por Papillomavirus/patologia , Fixação de Tecidos/métodos , Neoplasias do Colo do Útero/patologia , Adolescente , Adulto , Idoso , Brasil , Redução de Custos , Análise Custo-Benefício , Citodiagnóstico/economia , Feminino , Fixadores/economia , Custos de Cuidados de Saúde , Testes de DNA para Papilomavírus Humano/economia , Humanos , Biópsia Líquida , Metanol/economia , Pessoa de Meia-Idade , Teste de Papanicolaou , Infecções por Papillomavirus/economia , Infecções por Papillomavirus/virologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fixação de Tecidos/economia , Neoplasias do Colo do Útero/economia , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal , Adulto JovemRESUMO
George Nicolas Papanicolaou introdujo la citología diagnóstica de frotis vaginal en 1940, técnica de tamizaje de bajo costo y de aplicación masiva. Donde se implementó, ha permitido aumentar la detección del cáncer cérvico uterino en etapas precoces y de lesiones premalignas, reduciendo significativamente la mortalidad por esta causa. El frotis tecnificado, de alto costo, en teoría resuelve los cinco problemas de la convencional: 1) captura de la totalidad de la muestra, 2) fijación deficiente, 3) distribución aleatoria de células anómalas, 4) existencia de elementos perturbadores, 5) calidad del frotis. Estudios en grandes poblaciones no evidencian diferencias significativas en su capacidad diagnóstica comparados con la citología convencional que permitan sugerir su uso en el sistema público de salud.