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    A prevalência da junção escamocolunar em laudos citopatológicos realizados em serviços de atenção primária à saúde
    (Universidade Federal de São Paulo (UNIFESP), 2020-12-18) Tochetto, Liane De Oliveira Serra [UNIFESP]; Domenico, Edvane Birelo Lopes De [UNIFESP]; Universidade Federal de São Paulo
    Introduction: Cervical cancer is one of the tumors with the highest incidence in women, being the fourth more common worldwide and the third in Brazil. A considerable number of cases results from infections with the Human Papillomavirus, mostly located at the squamocolumnar junction (SCJ). Papanicolaou test is still the most accessible and one of the most efficient tests to obtain an accurate diagnosis, as long as epithelial samples, collected by means of a smear procedure, are satisfactory. Objectives: To identify the quality of the material collected for cancer cytology test by analyzing the prevalence of SCJ cells described in cervix cytopathological reports and verify the association between the prevalence of SCJ cells in cytopathological reports and the following variables: age, gestational status, inflammation, atrophy or atrophy with inflammation, microbiology, other cellular alterations, and professional who collected the sample. Methods: cross-sectional, descriptive, and quantitative study based on analysis of 1,251 reports of gynecological cancer cytology tests carried out at 16 Basic Health Units that offered services to the population in 51 neighborhoods in the Sapopemba administrative district of São Paulo, state of São Paulo, Brazil. The period for data collection was six months, from August 2018 to January 2019.Data were organized on the Visual Basic for Applications implementation and analyzed with the SPSS statistical software, version 20.0. The chi-squared test was used to analyze the association between two or more variables, and the test for equality of two proportions was used to compare answers for the same variable. The adopted level of significance was < 5%. Results: The epithelia that had more representativeness were the squamous (n=636; 50.8%) and the squamousglandular ones (n=368; 29.4%). The presence of SCJ was observed in 48.6% of the samples. The highest prevalence of SCJ was found in women between 25 and 39 years old (n=274; 56.1%; p<0.001). A statistically significant association was found between samples with the presence of SCJ and the fact that the material was collected by a nurse (n=510; 83.9%; p=0.022). Presence of SCJ was also associated with presence of inflammation (p=0.023), absence of atrophy (p<0.001), absence of atrophy/inflammation (p<0.001), presence of bacilli (p<0.001), absence of scarce flora (p=0.002), and presence of atypical cytology (p<0.001). Although cytological atypias were observed in only 4.8% of the reports with SCJ, there was a positive association between presence of these atypias and presence of SCJ (p<0.001). The association of presence of SCJ with moderate cytolysis (n=578; 95.1%; p<0.001) and with hypoestrogenism (n=594; 97.7%; p=0.02) was found, in addition to absence of SCJ and karyomegaly (n=640; 99.5%; p=0.014) and presence of erythrocytes (n=630; 98.0%; p<0.001). These data cannot be ignored, because these atypias can evolve into more serious alterations, and accurate diagnosis and preventive treatment could hinder the development of cervical cancer. Conclusion: The most important indicators in the determination of sample adequacy in cytopathological reports, representation of SCJ cells and presence of atypias, were found in numbers lower than expected, including in the group of women between 40 and 59 years old, which stressed the unsatisfactory quality of the performed cervical cancer screening.