Morphometric, immunocytochemistry and molecular analysis of cervicovaginal cytology with atypia of undetermined significance

Abstract

The cancer of the cervix is the third most common cause of malignant neoplasm of the female genital tract and the second most frequent cause of cancer in women in the world . There are approximately 500 thousand new cases per year. The incidence of cervical cancer is evident in the age group 20 to 29 years, and the risk increases, quickly, reaching its peak in the age group 45 to 49 years. Laboratory and epidemiological data support the conclusion that the Human Papilloma Virus (HPV) is the etiologic agent involved in the vast majority of cases of malignant epithelial lesions and pre-malignant cervical cancer, and the DNA of the virus detected in 95 to 100% of cases. However, in most cases, HPV infection is transient and not, necessarily, produces clinically significant lesions in the cervical mucosa. The prevalence of cancer of the cervix is low, compared with the high incidence of HPV infection. With the introduction of screening programs for cancer of the cervix, the incidence of cervical cancer decreased dramatically, but in any population, it was able to eliminate cervical cancer. The conventional cervical cytology has limitations, including low sensitivity for detecting pre-malignant lesions (50-75%). Moreover, the cervical cytology is not able to predict which pre-cancerous lesions will be clinically significant. The situation when the result of cytological examination is undetermined significance (ASC-US or ASC-H) is of particular interest in the potential risk of harboring a clinically significant lesion and the difficulty involved in clinical decision. In routine, we diagnosis ASC-US and ASC-H when the cytology involve cellular changes associated with inflammation, immature squamous metaplasia, atrophy or post-radiotherapy and this alterations can simulate the cytological changes observed in low-grade dysplasia or high grade. These situations require other methods to identify patients who present with or develop pre-neoplastic lesions. Thus, the objective of this study is to evaluate the contribution of the complement of diagnostic cytology with atypical undetermined significance with morphometric analysis, immunocytochemistry and viral genotyping of HPV. (AU)