AbstractIntroduction: This paper aims to develop a data warehouse (AD-SISCOLO) in order to support the management of the cervical cancer screening program in the municipality of Rio de Janeiro/Brazil. As a part of the management process, the program managers of the municipality perform tedious manual work in order to calculate a series of performance indicators and then take decisions based on them. Methods AD-SISCOLO was implemented using the Pentaho BI Suite Business Intelligence Platform and the MySQL database management system. The indicators to be calculated and visualized in the tool were based on the municipal data of the cytopathology and histopathology tests from January 2012 until December 2014, which was obtained from the Information System of Cervical Cancer (SISCOLO) after a record linkage process. The follow-up indicators were based on a simplified version of the Brazilian guidelines for the cervical cancer screening. Results AD-SISCOLO allows the visualization of a set of test-based and follow-up indicators from different views and dimensions, which enable managers to monitor all the phases of the screening process and to identify the process’ failures. Conclusions Compared with the current available environments in Brazil, AD-SISCOLO is unique in its visualization of the follow-up indicators of groups of women, according to their test results and age. Thereby it provides presentation flexibility to suit the program manager's needs.

CONTEXTO E OBJETIVO: A última atualização do Sistema Bethesda dividiu a categoria de células escamosas atípicas de significado indeterminado (ASCUS) em ASC-US (de significado indeterminado) e ASC-H (quando não se pode excluir lesão intra-epitelial de alto grau). Os objetivos deste estudo foram medir a prevalência da lesão pré-invasiva (Neoplasia Intra-epitelial Cervical, NIC II/III) e câncer cervical, de pacientes que foram encaminhadas ao Instituto Fernandes Figueira (IFF), com citologia ASC-H e compará-la com os casos ASC-US. TIPO DE ESTUDO E LOCAL: Estudo transversal com coleta de dados retrospectiva, que ocorreu no ambulatório de Patologia Cervical do IFF. MÉTODOS: Casos com diagnóstico de ASCUS recebidos no IFF entre novembro de 1997 a setembro de 2007, foram revisados de acordo com o Sistema Bethesda 2001 até um diagnóstico de consenso. Os casos ASC-H e ASC-US resultantes desta revisão, e os casos novos, foram analisados em relação ao desfecho de interesse. Consideramos padrão-ouro tanto a histologia como, nos casos sem diagnóstico histológico, o acompanhamento cito-colposcópico. RESULTADOS: A prevalência de NIC II/III na citologia ASC-H foi de 19,29% (intervalo de confiança, IC 95% 9,05-29,55%) e o risco destas lesões foi maior entre as pacientes com citologia ASC-H comparado às pacientes com citologia ASC-US (razão de prevalência, RP = 10,42; IC 95% 2,39-45,47; P = 0,0000764). A lesão pré-invasiva na citologia ASC-H foi mais frequente abaixo dos 50 anos (RP = 2,67; IC 95% 0,38-18,83), P = 0,2786998. Não houve casos de câncer do colo do útero. CONCLUSÕES: A prevalência de NIC II/III em pacientes com citologia ASC-H foi significativamente mais alta que a de ASC-US, e a divisão em subcategorias do diagnóstico ASC se mostrou com boa capacidade para discriminar a presença de lesões pré invasivas.

CONTEXT AND OBJECTIVE: The latest update of the Bethesda System divided the category of atypical squamous cells of undetermined significance (ASCUS) into ASC-US (undetermined significance) and ASC-H (high-grade intraepithelial lesion cannot be ruled out). The aims here were to measure the prevalence of pre-invasive lesions (cervical intraepithelial neoplasia, CIN II/III) and cervical cancer among patients referred to Instituto Fernandes Figueira (IFF) with ASC-H cytology, and compare them with ASC-US cases. DESIGN AND SETTING: Cross-sectional study with retrospective data collection, at the IFF Cervical Pathology outpatient clinic. METHODS: ASCUS cases referred to IFF from November 1997 to September 2007 were reviewed according to the 2001 Bethesda System to reach cytological consensus. The resulting ASC-H and ASC-US cases, along with new cases, were analyzed relative to the outcome of interest. The histological diagnosis (or cytocolposcopic follow-up in cases without such diagnosis) was taken as the gold standard. RESULTS: The prevalence of CIN II/III in cases with ASC-H cytology was 19.29% (95% confidence interval, CI, 9.05-29.55%) and the risk of these lesions was greater among patients with ASC-H than with ASC-US cytology (prevalence ratio, PR, 10.42; 95% CI, 2.39-45.47; P = 0.0000764). Pre-invasive lesions were more frequently found in patients under 50 years of age with ASC-H cytology (PR, 2.67; 95% CI, 0.38-18.83); P = 0.2786998). There were no uterine cervical cancer cases. CONCLUSION: The prevalence of CIN II/III in patients with ASC-H cytology was significantly higher than with ASC-US, and division into ASC diagnostic subcategories had good capacity for discriminating the presence of pre-invasive lesions.

OBJETIVO: Conhecer o perfil dos laboratórios de citopatologia que prestam serviços ao Sistema Único de Saúde (SUS) e elaborar indicadores de qualidade dos exames citopatológicos. MÉTODOS: Foi realizada uma enquete postal dirigida aos 1.028 laboratórios que prestaram serviço ao SUS e participaram do Sistema de Informação do Câncer do Colo do Útero (SISCOLO) em 2002. As informações referentes aos exames citopatológicos constantes do SISCOLO e disponibilizadas na página do Departamento de Informática do Sistema Único de Saúde (DATASUS) na Internet (<A HREF="http://www.datasus.gov.br/" target="_blank">www.datasus.gov.br</A>) para o mesmo ano foram analisadas. RESULTADOS: Dos 1.028 laboratórios que informaram os resultados dos exames citopatológicos cervicovaginais ao DATASUS, em 2002, 739 responderam à enquete (71,9%). Desses, 18,9% processaram 15 mil exames ou mais no ano; 70,2% eram privados; 50,2% encontravam-se vinculados à gestão municipal; e 48,7% realizavam exames histopatológicos. Em 74,8% dos casos o responsável técnico pelo laboratório era médico. Dos 10.505.773 exames incluídos no SISCOLO em 2002, uma parcela das amostras (1,66%) foi considerada insatisfatória. As alterações detectadas foram: células escamosas atípicas de significado indeterminado (ASCUS), 1,26%; papilomavírus humano (HPV), 0,93%; neoplasia intra-epitelial cervical I (NIC I), 0,84%; NIC II, 0,20%; NIC III, 0,17%; carcinoma escamoso invasivo, 0,05%; células glandulares atípicas de significado indeterminado (AGUS), 0,14%; adenocarcinoma in situ, 0,01; e adenocarcinoma invasivo, 0,01%. CONCLUSÃO: Este estudo permitiu avaliar o perfil dos laboratórios de citopatologia que prestaram serviço ao SUS em 2002, e o SISCOLO se mostrou um excelente instrumento para o monitoramento da qualidade dos exames citopatológicos realizados no país.

OBJECTIVE: To assess the profile of cytopathology laboratories which render services to the Brazilian Unified Health System (SUS), and to create quality indicators for cytopathological exams. METHODS: A postal survey of 1,028 laboratories that render services to the SUS and participated in the Cervix Cancer Information System (SISCOLO) in the year 2002. Information concerning cytopathological exams from the SISCOLO, available on the Internet (<A HREF="http://www.datasus.gov.br/" target="_blank">www.datasus.gov.br</A>) for the same year was analyzed. RESULTS: Out of the 1,028 laboratories which reported results of cervix-vaginal cytopathology exams to DATASUS in 2002, 739 answered the survey (71.9%). From these, 18.9% processed 15,000 exams or more in that year; 70.2% were private; 50.2% were vinculated to municipal administrations; and 48.7% performed histopathological exams. In 74.8% of cases, a physician was in charge of the technical responsibility. Out of 10,505.773 exams included in the SISCOLO in 2002, 1.66% of samples were considered unsatisfactory. The following alterations were detected: atypical squamous cells of undetermined significance (ASCUS), 1.26%; human papillomavirus (HPV), 0.93%; cervical intraepithelial neoplasia I (CIN I), 0.84%, CIN II = 0.20%, CIN III = 0.17%; invasive squamous carcinoma, 0.05%, atypical glandular cells of undetermined significance (AGUS), 0.14%, in situ adenocarcinoma, 0.01; and invasive adenocarcinoma, 0.01%. CONCLUSION: This study made it possible to assess the profile of cytopathology laboratories, which rendered services to the SUS in 2002, and the SISCOLO proved to be an excellent tool to assess the quality of cytopathological exams performed in Brazil.