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Type: Artigo de periódico
Title: Performance Of Pap Smear And Human Papilloma Virus Testing In The Follow-up Of Women With Cervical Intraepithelial Neoplasia Grade 1 Managed Conservatively.
Author: Santos, André Luis Ferreira
Derchain, Sophie Françoise Mauricette
Sarian, Luis Otávio
Martins, Marcos Roberto
Morais, Sirlei Siani
Syrjänen, Kari Juhani
Abstract: Conservative management (follow-up) of cervical intraepithelial neoplasia grade 1 (CIN1) is acceptable, but evidence on performance of follow-up tools, such as Pap smear and human papilloma virus (HPV) test, is still needed. A cohort of 78 women with histologically confirmed CIN1, referred because of atypical squamous cell or low-grade squamous intraepithelial lesion in their Pap smear, was enrolled between August 2000 and September 2002 and was prospectively followed-up at 6 and 12 months, until September 2003. Follow-up examinations included Pap test and Hybrid Capture II (HCII) with high-risk HPV, colposcopy, and cervical biopsies in patients with persistent abnormalities. Odds ratios and performance indicators (with 95% confidence interval) were calculated for HPV and Pap test results in detecting biopsy-confirmed CIN during the follow-up. Thirty-seven (47%) of the women were HPV-positive at baseline. At first follow-up visit, 30 women had persistent CIN1 and one woman progressed to CIN2; 15 patients had CIN1 and one patient CIN2 at the second follow-up visit. Women with persistent CIN1 (or progression) during follow-up had a significantly higher HPV detection rate and abnormal Pap tests, compared to women with regressive disease. Cytology had a far better sensitivity in detecting CIN than HCII at the first follow-up visit (81 versus 52%, respectively), whereas both examinations had equivalent sensitivities at the second follow-up visit (69 and 56%, respectively). Cytology had a superior negative predictive value at the first follow-up visit and better positive predictive value, in addition, at the second visit. Because cytological abnormalities correlated generally better with the persistence of biopsy-confirmed CIN1 in this follow-up protocol, HCII test is the second-hand option to Pap test, but the use of both Pap and HCII together seems an unnecessary waste of resources.
Subject: Adolescent
Cervical Intraepithelial Neoplasia
Cohort Studies
Disease Progression
Middle Aged
Odds Ratio
Papanicolaou Test
Papillomavirus Infections
Risk Factors
Vaginal Smears
Rights: fechado
Identifier DOI: 10.1080/00016340600604682
Date Issue: 2006
Appears in Collections:Unicamp - Artigos e Outros Documentos

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