Campaner Adriana B, Fernandes Gustavo L
School of Medical Sciences, Department of Gynecology and Obstetrics, Santa Casa de São Paulo, São Paulo, Brazil -
School of Medical Sciences, Department of Gynecology and Obstetrics, Santa Casa de São Paulo, São Paulo, Brazil.
Minerva Obstet Gynecol. 2024 Dec;76(6):532-539. doi: 10.23736/S2724-606X.23.05365-4. Epub 2023 Oct 25.
Considering the cervix at the climacteric period, important changes take place in the morphology of the epithelium and stroma due to hypoestrogenism. Therefore, the aim of the present study was to compare the presence of transformation zone cells in the cervix of premenopausal and postmenopausal women.
In a private laboratory in São Paulo (Brazil) a retrospective analysis of cervical cytology results was performed. A total of 1,026,671 satisfactory cytology tests were evaluated between January 2010 and December 2015.
A marked decline in transformation zone cells with age was evident, with a greater decrease in the ≥50 years age groups. Only 35% of women ≥50 years of age had transformation zone cells in cytology, while in those <50 years, the figure was 67.5% (P<0.001). The prevalence of negative cytological results in these two age groups was respectively 89.9% and 95.3%; however, it was observed that the most serious cytological results occurred in the group after menopause.
Although cytology is the recommended screening method for cervical cancer in Brazil, the low number of transformation zone cells in cytology in menopausal patients could be less sensitive for screening of dysplasia and cancer. So, we suggest routine high-risk HPV DNA testing, when possible, given that this test is considered more sensitive for detecting cervical lesions in this group of patients. When HPV DNA testing is not possible, cytology should be collected, and for cytology sampling we suggest regular topical estrogenization and use of appropriate technique.
考虑到更年期宫颈情况，由于雌激素水平降低，上皮和基质的形态会发生重要变化。因此，本研究的目的是比较绝经前和绝经后女性宫颈转化区细胞的存在情况。
在巴西圣保罗的一家私人实验室对宫颈细胞学检查结果进行回顾性分析。2010年1月至2015年12月期间共评估了1,026,671份满意的细胞学检查。
转化区细胞数量随年龄明显下降，≥50岁年龄组下降更为明显。≥50岁女性中只有35%的人在细胞学检查中有转化区细胞，而<50岁的女性这一比例为67.5%（P<0.001）。这两个年龄组细胞学检查结果为阴性的患病率分别为89.9%和95.3%；然而，观察到最严重的细胞学结果发生在绝经后组。
虽然细胞学检查是巴西推荐的宫颈癌筛查方法，但绝经患者细胞学检查中转化区细胞数量较少，对发育异常和癌症的筛查可能不太敏感。因此，我们建议尽可能进行常规高危型人乳头瘤病毒（HPV）DNA检测，因为该检测被认为对检测该组患者的宫颈病变更敏感。当无法进行HPV DNA检测时，应进行细胞学检查，对于细胞学采样，我们建议定期局部雌激素化并采用适当技术。
