Evaluation of cervical-vaginal cytology results among pregnant and non-pregnant women: specimen adequacy and evolutional aspects

Abstract

Introduction: Cervical cancer is the fourth most frequent cancer among women. Its etiology is intrinsically related to HPV infection, responsible for precursor lesions development, which can evolve to invasive cancer. These precursor lesions can be easily detected by preventive exams and classified according to Bethesda System, being curable in almost all cases.A quality and well-organized cytology-based screening program establishment in a country contributes essentially for decreasing disease´s mortality and incidence.Brazil has a cervical cancer screening program, but it still presents high incidence and mortality rates. Important factors related to its rates are the cervical-vaginal cytology low cover rate and the opportunistic program modality, in which only women looking for the healthcare assistance will undergo the exam, without any kind of restriction in relation to age and interval.Pregnant women have the same risk than non-pregnant women on presenting the disease or its precursor lesions. Cervical-vaginal cytology does not differ from non-pregnant women so, except for morphological changes related to pregnancy which can mimic malignancy.In Brazil there are few studies about association between abnormal cervical-vaginal cytology in pregnant and non-pregnant women with lesion category, age and follow-up (subsequent exams). Some professionals can present certain fear on realizing endocervical collect in pregnant women. But it is still unknown if this wrong performance can impact in cervical-vaginal cytology results between pregnant women considering cervical cancer screening.Objectives: To compare abnormal cervical-vaginal cytology results frequency among pregnant and non-pregnant women, at same age group, correlating cytological changes with biopsy results and posterior cytology; to compare if there is difference in abnormal cervical-vaginal cytology results when squamocolumnar junction representation in cytologic smear is present or not; to compare results between pregnant women attended in public and private healthcare systems; and to study cervical-vaginal cytology results and posterior biopsy/surgical specimens from women who presented abnormal cytological result during pregnancy in order to establish a neoplasia progression index.Methods: Observational analytical study about cervical abnormal results from pregnant and non-pregnant women between 18 and 34 years old in Araçatuba-SP, Brazil. The sample consists in conventional cervical-vaginal cytology, correspondent biopsies and surgical specimens, obtained by Instituto de Patologia de Araçatuba during 22 years. All results were reported by the same team of cytopathologists and cytotechnologists according to Bethesda System. There are about 600.000 cases, which will be stratified in three age groups. About 6.000 cases of these are from pregnant women.Aiming Results: Scientific articles with credits to the authors; the student training in scientific research; data creation which may guide public health policies about the cervical-vaginal cytology exams during pregnancy; and data presentation in regional, national and international congresses.