Alcances e limites do exame citopatolÃgico com coloraÃÃo de Papanicolaou no diagnÃstico das cÃrvico-vaginites: um estudo citolÃgico e microbiolÃgico de 2169 casos de um total de 10.064 exames citopatolÃgicos

AUTOR(ES)
DATA DE PUBLICAÇÃO

2004

RESUMO

The effect of Papanicolaou cytological cervical-vaginal examination on the reduction of the incidence of squamous-cell carcinoma failed to clarify the importance of this examination, regarding the diagnosis of cervical vaginitis, calling into question the Bethesda System (TBS). The improvements in TBS in the area of squamous intraepithelial lesions were not noted, where infections are concerned, despite advances in microbiological research. The author did a study based on a sample of 10,064 cytopathological exams of which 86% presented inflammation, (12.34% minor inflammation 66.22% moderate inflammation and 7.44% severe inflammation). Clinical criteria were applied in 2,169 cases which required microbiological tests. The microbiological test was represented by the culture in 94.85% of the cases. It showed similar relative frequencies, among the three most commonly-found types of flora in both cytopathological and microbiological tests (P<0,0001), i.e. Lactobacillus sp, Candida sp. and Gardnerella vaginalis. The latter was diagnosed based on the occurrence of âclue cellsâ. It was confirmed that the Papanicolaou method could be used in the cytological diagnosis of Lactobacillus sp., Candida sp., Leptotrix vaginalis and Trichomonas vaginalis. Moreover, the diagnosis of Gardnerella vaginalis based upon the identification of âclue cellsâ is reliable. The diagnosis of Actinomyces spp.,Chlamydia trachomatis, Streptococcus sp. is also possible, along with the probable presence of Mobiluncus spp. We can confirm that the codifying of the F1 and F11 floras is not applicable. As a consequence of this study, we propose the following modifications in the category of TBS infections, in relation to the specification of the microorganisms: 1) Retaining the Lactobacillus sp. Item. 2) Substituting âShift in the vaginal flora compatible with Vaginosisâ for âGardnerella vaginalis with the presence of âclue cellâ 3) Including the topic concerning âAlteration of flora to be clarified by way of a microbiological testâ. The latter point would enable the cytopathologist to inform the clinic of the necessity of investigating suspected cases of infection which had been subjected to a cytological examination.

ASSUNTO(S)

coloraÃÃo de papanicolaou doenÃas sexualmente transmissÃveis do trato genital feminino esfregaÃo cÃrvico-vaginal anatomia patologica e patologia clinica cÃrvico-vaginites

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