Avaliação da reprodutibilidade do coteste (colpocitologia cervical e DNA HPV) em centros de referência de saúde da mulher na região metropolitana de Belo Horizonte

Abstract

Cervical cancer, whose main etiological factor is persistent infection with some types of Human papillomavirus (HPV), is an important public health problem in the world and in Brazil. The tracking of precursor lesions of this neoplasia, in our country, is based on the Papanicolaou test, which has important pre-analytical and accuracy limitations. In order to improve the performance of conventional cytology, liquid based cytology (LBC) and molecular techniques, such as polymerase chain reaction (PCR), were developed, licensed and incorporated, alone or together, to detect and genotype DNA of HPV. Considering the possible advantages of simultaneously incorporating LBC and DNA-HPV tests, this study evaluated the reproducibility of the cotest (LBC and DNA-HPV) as a screening strategy for cervical cancer. To this end, samples of cervicovaginal fluid were processed to make slides using the ClearPrep®️ technique and for HPV detection and genotyping using the Abbott RealTime High Risk (HR) HPV kit. 1,149 participants were selected, of which 1,069 were included in the study and molecularly tested. Of these participants, 551 samples were subjected to pre-analytical and interobserver variability assessments in cytology. The results show a predominance of the moderate pre-analytical criteria, considered excellent, of cell staining and dispersion (averages of 72.9% and 73.5%, respectively), in addition to autolysis and cellular clusters that are mostly absent or few in number (averages of 79.6% and 74.3%, respectively), on cytological slides. In the intraobserver comparison of the first with the second diagnosis of abnormalities in squamous and glandular epithelial cells, no statistically significant differences were observed for any observer. Regarding interobserver agreement, higher Kappa coefficients were observed in all comparisons in the second cytopathological diagnosis, with emphasis on diagnoses of abnormality in squamous cells, which cannot exclude high-grade lesions, and low- and high-grade squamous intraepithelial lesions. Regarding HPV detection and genotyping, a prevalence of 27.32% of high-risk HPV (HR-HPV) was observed in the study population, with a predominance of other types of HR-HPV other than HPV-16 and HPV -18, especially in age groups over 45 years old. Isolated, HPV-16 had the highest percentage of detection (20.20%), with a predominance in age groups under 45 years old. In conclusion, the results indicate analytical disadvantages of the cotest in cervical cancer screening, replacing the conventional Pap smear, despite the excellent pre-analytical analysis, and reinforce the need for specific training for LBC interpretation. Additionally, the results show a high prevalence of HR-HPV in our region, with a large presence of other types of HR-HPV other than 16 and 18. Financial support: CNPq and FAPEMIG