Recomendações para o uso de testes de DNA-HPV no rastreamento do câncer do colo útero no Brasil

Zeferino, Luiz Carlos; Bastos, Joana Bragança; Vale, Diama Bhadra Andrade Peixoto do; Zanine, Rita Maria; Melo, Yara Lucia Mendes Furtado de; Primo, Walquíria Quida Salles Pereira; Corrêa, Flávia de Miranda; Val, Isabel Cristina Chulvis do; Russomano, Fábio

doi:10.1055/s-0038-1657754

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Review Article • Rev. Bras. Ginecol. Obstet. 40 (06) • Jun 2018 • https://doi.org/10.1055/s-0038-1657754 copiar

Recomendações para o uso de testes de DNA-HPV no rastreamento do câncer do colo útero no Brasil

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

O uso de diretrizes clínicas baseadas em evidências visa assegurar as melhores práticas na área de cuidado à saúde. O uso de testes de ácido desoxirribonucleico de papilomavírus humano (DNA-HPV) vem crescendo e se disseminando sem que existam recomendações de uso no cenário brasileiro.Emnomeda Associação Brasileira de Patologia doTrato Genital Inferior e Colposcopia (ABPTGIC), grupos de revisores pesquisaram evidências e formularamrecomendações para o uso dos testes de DNA-HPV no rastreamento do câncer do colo do útero, no seguimento de mulheres com atipias citológicas, e após tratamento de neoplasia intraepitelial cervical (NIC). O produto desse processo foi debatido e foi buscado consenso entre participantes. Os testes de DNA-HPV são recomendados num cenário de rastreamento organizado para identificação de mulheres portadoras de lesões precursoras ou câncer assintomático com mais de 30 anos e podem ser realizados a cada 5 anos. Também têm valor após a citologia mostrando células escamosas atípicas de significado indeterminado (ASC-US) ou lesão intraepitelial escamosa de baixo grau (LSIL) como teste de triagempara colposcopia, na investigação de outras alterações citológicas quando não são observados achados anormais à colposcopia, buscando excluir doença, ou, ainda, no seguimento após tratamento das neoplasias intraepiteliais de alto grau, para exclusão de doença residual.

Palavras-chave:
rastreamento; neoplasias do colo do útero; sondas de DNA de HPV; neoplasia intraepitelial cervical; citologia

Certainty Level^* The United States Preventive Services Task Force (USPSTF) attributes a level of certainty based on the general nature of the evidence available to assess the net benefit of a preventive practice.3	Description
High	The available evidence usually includes consistent results from well-designed and well-conducted studies among the representative populations to which they apply. These studies assess the effects of the preventive practice on health outcomes. This conclusion is therefore unlikely to be strongly affected by the results of future studies.
Moderate	The available evidence is sufficient to establish the effects of the preventive practice on health outcomes, but confidence is limited by factors such as:• The number, size or quality of the individual studies• Inconsistency in the findings across individual studies• Limited generalizability of the findings to the routine practice• Lack of consistency in the chain of evidenceAs more information becomes available, the magnitude or direction of the observed effect may change, and this change may be large enough to alter the conclusion.
Low	The available evidence is insufficient to assess effects on health outcomes. The evidence is insufficient because of:• The limited number or size of the studies• Important flaws in the studies' designs or methods• Inconsistency in the findings across individual studies• Gaps in the chain of evidence• Findings not generalizable to the routine practice• Lack of information on important health outcomesMore information can allow estimates of the effects on health outcomes.

Grade	Definition^* The United States Preventive Services Task Force (USPSTF) defines certainty as the “likelihood that the USPSTF's assessment of the net benefit of a preventive practice is correct.” The net benefit is defined as the benefit minus the practice injury when implemented in a general population.2	Recommendations for practice
A	The practice is recommended. There is high certainty that the net benefit is substantial.	Offer or provide the practice.
B	The practice is recommended. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.	Offer or provide the practice.
C	The practice is not routinely recommended. There may be considerations that support the practice at an individual level. There is at least moderate certainty that the net benefit is small.	Offer or provide this service for selected patients depending on individual circumstances.
D	The practice is not recommended. There is moderate or high certainty that the practice has no net benefit, or that the damages outweigh the benefits.	Discourage the use of this practice.
I	The current evidence is insufficient to assess the balance between its benefits and harms. The evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.	Read the introductory text containing evidence obtained in the literature review that supports this recommendation. If the practice is offered, the patients should understand that there is uncertainty in the balance between benefits and harms.

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[1] Address for correspondence Fábio Russomano, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, da Fundação Oswaldo Cruz, Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ 22250-020, Brazil (e-mail: fabiorussomano@gmail.com).