Evaluation of the techiniques used in the Pap smear fixation in cervical cancer screening / Avaliação das tecnicas de fixação do esfregaço citopatologico no rastreamento do cancer de colo uterino

AUTOR(ES)
DATA DE PUBLICAÇÃO

2007

RESUMO

To describe the current process of production, distribution and use of the fixative in the Basic Health Units (BHU), from Campinas, SP, the human resources and available materials to the smear test collection as well as the used fixation techniques, and to compare the quality of the Pap smears collected in the BHU, by using the different fixation techniques. It was developed a descriptive, comparative and prospective study. The sample was of 2114 Pap smears in 43 BHU, in which were observed information about the physical space conditions, manner of storage of the fixative, fixation techniques of the used Pap smears, the professional responsible for the collect, and the current process of production, distribution and use of the fixative in the BHU. The distribution of the fixative to the BHU was divided into three groups, with three types of fixation: drops, spray and alcohol. The smears were analyzed in the Cytopathology Laboratory from CAISM in the State University in Campinas. In 93% of the BHU, the fixatives are stored in cabinets, and in 60,5% of the labels there was no fabrication date. The most used fixation technique was drops (93%) and the flask shake was performed in 86% of the BHU. The light incidence on the fixative was observed in 90,6%. The fixative change occurs in 46,5% weekly and in 81,4% it was observed that the flasks were found closed in the BHU. The exams are performed in the BHU by 86% nurse auxiliary, 84% by physicians, and in 51% by nurses. In physical environment, it was observed that 65% of the BHU had ventilators in the collect room, in 97,6% there were windows and from these, in 73,8%, the windows were opened during the collect procedure. The frequencies of results “satisfactory, but limited by fixation” vary between 14,9% to 23,2%, being significantly lower when the spray fixative is used (p<0,0001). The frequency of results “satisfactory, but limited by the absence of glandular and metaplasic cells”, with different types of fixatives, varied from 13,8% to 22,3%, with lower taxes when the spray is used (p=0,0001). There was no significant difference in relation to the lesions of low and high grades, comparing the different fixation types. When alcohol in 95% fixation was done, it was observed a higher frequency of the ASCUS diagnosis (p=0,0025). The production of the cellular fixative is inside the patterns described in literature. The fixative use must be reviewed, observing the changes, validity date, maintenance of the flask (closed and in a heat-protected place). In most of the visited BHU, the professional responsible for the collect are nurse auxiliaries or physicians that use the drop fixation. The physical environment is according to the norms described in literature. The fixation technique that presented the best performance was spray. This can be a more adequate alternative to be implanted in the routine of the Pap smear collect. The alcohol in 95% fixation raised the ASC-US identification, which needs better evaluation and analysis. The Pap smears in which the fixation technique polyethylene glycol and alcohol 95% in spray and alcohol in 95% was used, presented lower frequency of satisfactory results, but limited by the absence of glandular and metaplasic cells. This findind also needs better investigation. Key words: Vaginal smears, Uterine Cervical Neoplasm, Quality control, Cytology, Fixatives.

ASSUNTO(S)

controle de qualidade uterine cervical neoplasm cytology citologia fixatives esfregaço vaginal neoplasia do colo uterino quality control vaginal smears

ACESSO AO ARTIGO

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