Manejo conservador em neoplasia intraepitelial cervical de alto grau

Abstract

Objective:The aims were to evaluate the association of the lesion area with the presence of residual lesion and compromised surgical margins in cervical intraepithelial neoplasia (CIN) 2/3, to evaluate the association of CIN with laboratory parameters, to verify the PCR performance in CIN 2/3 detection and propose a conservative CIN 2/3 management based on the lesion area. Study Design: The study evaluated 51 patients diagnosed with low-grade and high grade squamous intraepithelial lesion. The colposcopic images were captured and the lesion area was calculated in pixels2 . Polymerase Chain Reaction (PCR) for high risk and low-risk HPV was performed. Blood samples were collected for evaluation of blood count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and Red Cell Distribution Width (RDW). ROC curve was used to obtain cut-off of lesion area. Spearman's correlation test was used for laboratorial parameters and lesion area evaluation. PCR performance in the detection of high-grade CIN was calculated. Flowchart was designed to compare the costs of procedures in Brazilian Health System. Results: Evaluating all patients with CIN 2/3 treated with excisional surgery, ROC curve was used to determine the best cut-off value of the lesion area below which there was no residual lesion, and value of 21,019 pixels2 was found. Evaluating the cut-off value that could be used to predict the presence of compromised surgical margins, the value of 155,577.65 pixels2was found. Assessing all patients with CIN, there was an inverse correlation of the lesion area with NLR (r=-0.446 and p=0.001), PLR (r=-0.438 and p=0.001) and absolute number of leukocytes (r=-0.351, p=0.011). Negative predictive value of PCR was 77.78% for the detection of high-grade CIN. If we opted for conservative clinical treatment with semi-annual clinical follow-up, this management shows savings with direct costs for Brazilian Health System of R$ 909.82 (169.42dollars). Conclusion: The presence of CIN already reflects a systemic alteration, leading to altered values of NLR, PLR and absolute number of leukocytes. In addition, patients with high-grade cervical intraepithelial neoplasia with colposcopy lesions smaller than 2,019 pixels2 could benefit from conservative management, with savings for the Brazilian Health System.