Description of Referrals for Colposcopy in a Hospital in Brazil

To describe the referral for colposcopy in a Hospital in Brazil and the relative frequency of patients who benefited from it, considering the correct indications for the examination and its final diagnoses.

Methods

A retrospective study was performed in the colposcopy service database of the Hospital Universitário de Taubaté, Taubaté, state of São Paulo, Brazil. The frequency validated in the analysis of the medical records of women referred for clinical indication or cytological alteration, attended from March 2015 to March 2017. The population selected and analyzed included 256 results that were correlated to the cytological, clinical data and the result of the colposcopy.

Results

Of the women referred, 45% presented out of the age of screening according to the guidelines of cervical cancer screening, 8.6% being adolescents and young adults < 25 years old, and 36.4% of the patients being ≥ 65 years old. A total of 50% of the patients had no indication of colposcopy, that is, normal cytologies, benign changes, ectopia, cervicitis, atypical squamous cells of indeterminate significance (ASC-US) and low-grade intraepithelial lesion (LSIL) without persistence and normal clinical appearance. A total of 39.84% who underwent colposcopy had high-grade lesion or cancer results, thus benefiting from the adequate referral.

Conclusion

Most (60.16%) of the patients referred to the colposcopy service did not benefit from the referral for results without changes, such as negative colposcopies, histologies with no cervical intraepithelial neoplasm (CIN) or only CIN 1, or were out of the age for screening. These findings therefore demonstrate a significant number of unnecessary and inadequate referrals.

Keywords
colposcopy; neoplasms of the cervix; prevention; histology

Cytology	Normal Colposcopy		Altered Colposcopy				Total
Cytology	Normal Colposcopy		Negative		Positive		Total
	n	%	n	%	n	%	n	%
AGC	01	0.4	05	2.0	01	0.4	07	2.8
ASC-US	05	2.0	36	14	12	4.7	53	20.7
ASC-H	0	0	10	3.9	10	3.9	20	7.8
LSIL	13	5.1	33	12.9	18	7.0	64	25
HSIL	01	0.4	08	3.1	61	23.8	70	27.3
Negative	16	6.2	12	4.7	0	0	28	10.9
Alt Clinical	02	0.8	12	4.7	0	0	14	5.5
Total	38	14.9	116	45.3	102	39.8	256	100

Age (years old)	Absence of CIN		CIN 1		CIN 2/3		AIS		Invasive CA		Total
Age (years old)	n	%	n	%	n	%	n	%	n	%	n	%
< 25	09	4.1	06	2.8	02	0.9	0	0	0	0	17	7.8
25-34	08	3.7	09	4.1	34	15.6	0	0	0	0	51	23.4
35-44	24	11	04	1.8	23	10.5	01	0.5	0	0	52	23.8
45-54	31	14.2	09	4.1	22	10	01	0.5	03	1.4	66	30.2
55-64	06	2.8	0	0	06	2.8	0	0	0	0	12	5.6
≥ 65	08	3.7	02	0.9	06	2.8	02	0.9	02	0.9	20	9.2
Total	86	39.5	30	13.7	93	42.6	04	1.9	05	2.3	218	100

Cytology	Histopathology
Cytology	Negative		CIN 1		CIN 2/3		AIS		Invasive CA		Total
	n	%	n	%	n	%	n	%	n	%	n	%
AGC	05	2.3	0	0	01	0.5	0	0	0	0	06	2.8
ASC-US	24	11	12	5.5	10	4.6	0	0	02	0.9	48	22
ASC-H	10	4.6	0	0	10	4.6	0	0	0	0	20	9.2
LSIL	17	7.8	16	7.3	17	7.8	01	0.5	0	0	51	23.4
HSIL	07	3.2	01	0.5	55	25.2	03	1.4	03	1.4	69	31.7
Negative	11	5.0	01	0.5	0	0	0	0	0	0	12	5.5
Alt Clinical	12	5.5	0	0	0	0	0	0	0	0	12	5.5
Total	86	39.4	30	13.8	93	42.7	04	1.9	05	2.3	218	100

Federação Brasileira das Sociedades de Ginecologia e Obstetrícia Av. Brigadeiro Luís Antônio, 3421, sala 903 - Jardim Paulista, 01401-001 São Paulo SP - Brasil, Tel. (55 11) 5573-4919 - Rio de Janeiro - RJ - Brazil
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[1] Address for correspondence André Luis Ferreira Santos, MD, PhD, Departamento de Ginecologia, Universidade de Taubaté, Taubaté, SP, Brazil (e-mail: andremedicinaunitau@gmail.com).