Proposta de manejo conservador de lesão intraepitelial cervical de alto grau utilizando análise de parâmetros inflamatórios

Abstract

Introduction: Cervical cancer, despite being a preventable disease, remains a global public health challenge and has a high incidence in Brazil. The objectives of the study are to measure the area of colposcopic lesions and verify their association with the absence of pathological lesions in the treatment of HSIL. And to verify if local inflammatory parameters (vaginal cytokine levels) and systemic parameters (blood count parameters) can influence the presence or absence of residual pathological lesions in the surgical specimen of LEEP (Loop Electrosurgical Excision Procedure), conization or hysterectomy in the treatment of HSIL (High-Grade Squamous Intraepithelial Lesion). And also to test a low-cost colposcope prototype coupled with a smartphone for performing colposcopies. Methods: This is a prospective cohort study. Seventy-seven patients who underwent surgical treatment for CIN II or CIN III confirmed by colposcopy-guided biopsy were evaluated. Clinical and colposcopic data, cytology and biopsy results, type of surgery performed, and anatomopathological findings of the surgery were recorded. Colposcopy and biopsy were performed, in addition to blood collection for complete blood count and vaginal secretion collection for evaluation of cytokine levels IL-1, IL-6, IL-8, IL-10, IL-12, and TNF-alpha using ELISA. ROC curve, Mann-Whitney test, and subsequent multivariate analysis were used. The significance level was considered lower than 0.05. The low-cost colposcope prototype coupled with a smartphone was tested by the medical team that performed the colposcopies. Results: An association of absence of residual lesion was found with vaginal IL-1 levels (cutoff value ≤ 141.4 pg/mL, AUC = 0.825, p = 0.001). There was no association with the colposcopic lesion area. When comparing medians, vaginal IL-1 levels were higher in patients without residual lesions in the surgical specimen than in those with residual lesions (349.1 pg/mL vs. 96.2 pg/mL; p = 0.0032). After multivariate analysis, IL-1 remained an independent factor associated with the presence or absence of residual lesions in the surgical specimen [OR (95% CI) = 0.115 (0.017–0.773), p = 0.026]. Regarding the prototype colposcope tests, although the device still needs improvement, its handling proved relatively easy, its transport presented no difficulties, and obtaining images with 10x magnification was effective with good focusing, despite the need for auxiliary lighting. There were no complaints from patients regarding differences in discomfort between the examination performed with the conventional device and the prototype. Conclusion: Levels of IL-1 in vaginal secretion are higher in patients without residual high-grade lesions in the surgical specimen. Studying immune and inflammatory response is important for a more conservative management of high-grade intraepithelial lesions in the future. Further testing of the low-cost colposcope prototype is needed to make it viable and effective in clinical practice.