School of Medicine, Centro Universitário Católico Unisalesiano Auxilium, Araçatuba, São Paulo, Brazil.
Pathology Institute of Araçatuba, São Paulo, Brazil.
Eur J Obstet Gynecol Reprod Biol. 2023 Mar;282:161-167. doi: 10.1016/j.ejogrb.2023.01.027. Epub 2023 Jan 24.
To compare the prevalence of abnormal cervical smear results among pregnant and non-pregnant women with and without representation of the transformation zone (TZ) in a mid-sized city in Brazil.
This observational analytical and retrospective study analyzed cervical smear results from pregnant and non-pregnant women in a mid-sized city in Brazil. Private data were collected at private clinics over seven years and from public services over 16 years. All results were reported according to Bethesda System. Pregnant women were separated from non-pregnant women, and women were stratified into two age groups (25-29 years and 30-34 years) in general analyses. For TZ representation and cytologic-histologic correlation, there was no age stratification.
Among public services cervical smears, the frequency of atypical squamous cells of undetermined significance (ASC-US) was higher for pregnant women in the entire group (odds ratio [OR] 1.91; confidence interval [CI] 1.07-3.39) and among women from 30 to 40 years old (OR 2.79; CI 1.38-5.66). The same occurred for low-grade squamous intraepithelial lesion (LSIL) in the total group (OR 3.50; CI 1.44-8.53) and among women 30 to 40 years old (OR 4.57; CI 1.45-14.42). The frequency of ASC-US was higher in pregnant women with TZ representation exams than those without (OR 4.62; CI 2.17-9.84). The same occurred for those with atypical squamous cells, which cannot exclude high-grade squamous intraepithelial lesion (OR 9.81; CI 1.63-59.15) and LSIL (OR 10.47; CI 3.39-32.36). Among pregnant women with abnormal cervical smear results, 85.74% were followed up through cytology, and an average of 26.12% of patients underwent biopsy, of which almost all were positive for dysplasia.
Pregnant and non-pregnant women did not differ in cervical smears with actual precursor lesions. Nevertheless, considering the opportunistic nature of Brazilian cervical cancer screening, prenatal visits present an opportunity to perform cervical smears in pregnant women. TZ representation correlated with higher rates of abnormal cervical smears, reinforcing the clinical importance of endocervical/metaplastic cell representation, including among pregnant women.
比较巴西一个中等城市中，有和无转化区（TZ）代表的孕妇和非孕妇的异常宫颈抹片结果的发生率。
这是一项在巴西一个中等城市进行的观察性分析和回顾性研究，分析了来自该城市私人诊所和公共服务机构的孕妇和非孕妇的宫颈抹片结果。私人诊所的数据采集时间为 7 年，公共服务机构的数据采集时间为 16 年。所有结果均按照巴氏系统进行报告。将孕妇与非孕妇分开，并将女性分为两个年龄组（25-29 岁和 30-34 岁）进行一般分析。对于 TZ 代表和细胞学-组织学相关性，没有进行年龄分层。
在公共服务机构的宫颈抹片中，整个组中，有 TZ 代表的孕妇的非典型鳞状细胞意义不明确（ASC-US）的频率更高（比值比 [OR] 1.91；置信区间 [CI] 1.07-3.39），30-40 岁的女性中也是如此（OR 2.79；CI 1.38-5.66）。同样，总组中低度鳞状上皮内病变（LSIL）的频率也更高（OR 3.50；CI 1.44-8.53），30-40 岁的女性中也是如此（OR 4.57；CI 1.45-14.42）。有 TZ 代表的孕妇的 ASC-US 频率高于没有 TZ 代表的孕妇（OR 4.62；CI 2.17-9.84）。对于不能排除高级别鳞状上皮内病变（OR 9.81；CI 1.63-59.15）和 LSIL（OR 10.47；CI 3.39-32.36）的非典型鳞状细胞的孕妇也是如此。在有异常宫颈抹片结果的孕妇中，85.74%通过细胞学进行了随访，平均有 26.12%的患者进行了活检，几乎所有患者的组织学结果都为异常增生。
有实际癌前病变的孕妇和非孕妇的宫颈抹片没有差异。然而，考虑到巴西宫颈癌筛查的机会性，产前检查为孕妇提供了进行宫颈抹片的机会。TZ 代表与更高的异常宫颈抹片率相关，这强化了包括孕妇在内的 TZ 代表的重要性。
