Conventional cytology Pap smear; Co-testing; Ectopy. To analyze the cytological findings in conventional cytology Pap smear (CPS) and Liquid-based cytology (LBC) with HPV testing (Co-testing) in women with ectopy in reproductive age.
From November 2010 to June 2015, we selected 53 women in reproductive age, with ectopy confirmed by colposcopy, without therapeutic intervention, negative CPS for malignancy and no signs suggestive of cytopathic effect by the Human Papilloma Virus (HPV). Women treated with abrasive or surgical techniques, pregnant, lactating and immunosuppressed in general were not included. We collect new samples for LBC and HPV DNA test (Cobas®, Roche), in Thin Prep® jars and processed by private laboratory. Both cytological reports obeyed Naming System Bethesda 2001. We confronted the reports, the representation of the epithelia, vaginal microbiota and the positivity of HPV testing correlated with risk factors.We offered free informed consent and the study was approved by the Research Ethics Committee.
The mean values in years for age, menarche, first sexual intercourse, interval between menarche and first sexual intercourse were 25.6; 12.2; 17.8 and 4.6 respectively. For parity 0.6 children and 3 for number of partners; 79% used hormonal contraceptives and 98% were non-smokers. The symptoms occurred in 50.9%, of which discharge 44.4%, pelvic pain 11%, postcoital bleeding 7.4% and their association 37%. The result of the CPS was 96.2% reactive/reparative and 3.8% Normal; 58.5% of squamous and glandular epithelia, 22.6% of the 3 epithelia, 17% squamous and columnar epithelium 1.9%. LBC revealed 83% reactive / reparative, 15% ASC-US and 2% LIEBG; of which 79.3% of the samples contained representation of the 3 epithelia and squamous only 20.7%. The HPV DNA test was positive in 34%, 33.3% of women aged 25 or more. The average age of the group HPV positive was statistically less than the HPV negative (p = 0.017). The microbiota in the CPS was 47% Lactobacillus sp, bacilli and other bacilli 28.3% and bacterial vaginosis (BV) 1.9% and LBC was Lactobacillus sp 24.5%, bacilli 39.6%, mixed 17%, and BV 11.3%.
The study shows the incidence of ectopy in young women, nulliparous, symptomatic predominantly of vaginal discharge, hormonal contraceptive users, but non-smokers. The negative and inflammatory report was the most frequent in both cytological methods, however LBC showed no change detected in CPS by 17%. The isolated finding of the squamous epithelium in women with ectopy was higher at LBC. The deviation of the microbiota to BV was higher in LBC. The positivity for high risk HPV DNA was significant in patients younger than 25 years.
1. Machado Junior LC, Dalmaso AS, Carvalho HB. Evidence for benefits from treating cervical ectopy: Literature review. Sao Paulo Med J 2008;126:132–139.
2. Monroy OL, et al Prevalence of human papillomavirus genotypes, and mucosal IgA anti-viral responses in women with cervical ectopy. Journal of Clinical Virology 47 (2010) 43–48.
3. Junior JE, Giraldo PC, Gonçalves AK, do Amaral RL, Linhares IM.Uterine cervical ectopy during reproductive age: cytological and microbiological findings. Diagn Cytopathol. 2014 May; 42(5):401-4.
4. Solomon D, Davey D, Kurman R, et al.; forum group member: Bethesda 2001 workshop. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA 2002; 287:2114–2119.
5. Singh VB, Gupta N, Nijhawan R, Srinivasan R, Suri V, Rajwanshi A. Liquid- based cytology versus conventional cytology for evaluation of cervical Pap smears: Experience from the first 1000 split samples. J Pathol Microbiol 2015; 58: 17-21.
6. Buntinx F, Essed GG, Van der Putten HW, Buchholz RF, Arends JW, Knottnerus JA. Composition of cervical smears in patients with and without a cervical ectropion. J Clin Pathol 1995; 48:408–409.
7. Saslow et al/ Screening Guidelines for the Prevention and Early Detection of Cervical Cancer Am J ClinPathol012;137:516-542.