Abstract

SANTOS, Fernanda  and  PACHECO, Amália. Persistent inflammatory pap smears: there will be obligation to refer?. Acta Obstet Ginecol Port [online]. 2018, vol.12, n.1, pp.28-35. ISSN 1646-5830.

Overview: Although low sensitivity of cervical cytology, this screening test was responsible by 70 to 80% reduction of incidence and mortality of cervical cancer worldwide. Inflammation is a common finding, that could be meaningless, could occlude premalignant lesions or could represent an oncological risk. Aims: To analyze cases of persistent inflammatory pap smears and their association with intraepithelial high grade lesions or carcinoma. Study Design: Cross-sectional study. Methods: Two hundred sixty cases of women with persistent inflammatory smears, opportunistically admitted to a tertiary unit, from January 2013 to December 2015, were revised. Statistical analysis was performed by STATA 13.1 program. Results: Two hundred sixty cases were analyzed, 13% in 2013 (91/692), 12% in 2014 (76/624) and 14% in 2015 (93/649). The mean age was 41 years, 60% were under hormonal contraception and 15% were postmenopausal. It was performed 106 human papillomavirus (HPV) typifications, 95 were negative, one positive to HPV-18 and 10 positive to others high-risk HPV. Considering patients follow-up, 15.4% (n=40) colposcopic abnormal findings were identified, 67.5% grade 1 and 32.5% grade 2. Thirty nine colposcopy guided biopsies were carried out. Histologically, 15 cases of cervicitis were identified, 12 of squamous metaplasia, 11 of low grade squamous intraepithelial lesion (LSIL) and one of high grade (HSIL). Ten women were submitted to treatment, four to excision of transformation zone (histology: three LSIL and one HSIL) and six to cryotherapy. 74%(n=192) had medical discharge after eighteen months, 13%(n=35) missed next appointments, 10% (n=25) maintain follow-up and 3% (n=8) were readmitted (3 LSIL, 1 atypical squamous cells of undetermined significance and 1 that cannot exclude HSIL, 2 persistent inflammation and 1 vulvar condilomatosis). Conclusion: In conclusion, the persistence of pap smears partially obscured by inflammation should persist to be targeted, until prospective and randomized trials are not performed.

Keywords : Papanicolau test; Cervix uteri; Inflammation; Intraepithelial high grade lesions.

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