Pre-malignant and malignant lesions of the uterine cervix: diagnosis, follow-up and treatment following the guidelines recommended by the Brazilian Ministry of Health.
Cervical cancer, cytopathological examination, conization, high-grade cervical intraepithelial lesions, electrosurgical excision, residual lesion
Objective: To evaluate the referral, diagnosis, follow-up and treatment of patients with abnormal cervical cytology to a Medium-Complexity Unit (MCU) following the guidelines recommended by the Brazilian Ministry of Health. Methods: This is a retrospective descriptive study, based on abnormal cervical cytology of users of the Unified Health System, city of Salvador, Bahia, from January 2017 to January 2020. Methods: This is a retrospective descriptive study, developed at the Women's Hospital, Salvador, Bahia, where data were collected from electronic medical records, from January 2017 to January 2020. The variables as: abnormal cervical cytology results (pre-malignant and malignant squamous lesions), colposcopic, histopathological and clinical follow-up as well as applied treatment methods were collected. Data analysis was performed with IBM SPSS 20. Results: 908 patients were referred to the MCU. Of the total, 812 (89,4%) were in the age according to the guidelines of cervical cancer screening. Most patients were classified as more severe squamous lesions (ASC-H/HSIL/CEC), while 21.7% were classified as less severe squamous lesions (ASC-US/LSIL). CIN II/III was the most observed histopathological diagnosis in the study. Follow-up of repeat cytological was more observed in the group with less severe squamous lesions, while LEEP was the most used procedure in the treatment of more severe squamous lesions. Of patients underwent excisional procedure, most (71.6%) treated with LEEP and 132 (28.4%) treated with CKC. Compared to LEEP, patients undergoing CKC were significantly younger (p=0.019). Associations were observed regarding margin evaluation (p<0.001), glandular involvement (p<0.001). As for the presence of residual lesion, parameters such as age ≥35 years old (p=0.028) and margin status (p<0.001) were statistically significant in association with lesion persistence. Conclusion: Although most referrals was in accordance with Brazilian Ministry of Health recommendations, there is a significant frequency of inappropriate and unnecessary referrals to a MCU for colposcopy and biopsy. Regarding residual lesion, age ≥35 years and positive margin may be associated with persistence of CIN II/III.