Cumplimiento del protocolo de atención a citologías con Ascus, en la población afiliada a Coomeva EPS

Abstract

In this inquiry are presented the study results of atypical squamous cells of undetermined significance (ASCUS), in the affiliated population to Coomeva EPS during the period from January to June 2014. About the compliance of protocol, it was checked that thelapse of time between the taking of samples and the delivery of results has a minimum of 6 and a maximum of 18 days; the times that more are repeated the delivery of samples are 3 at day 8 and the average samples are 1,57 with 12,28 days to the delivery. It was found that 10 of the 11 patients are remitted to gynecology to benign changes control and the other patient is remitted equally with another type of abnormalities, performing to everyone colposcopy and biopsy. The minimum lapse of time between the exam order and the sample taking is of 6 days, the longest time was 104 days for an average of 31.81 days. Among the 12 patients all times were independent. The biopsy results confirmed more serious diagnoses of epithelial cell abnormalities with 10 cases of low-grade squamous intraepithelial lesion (LGSIL), corresponding to 1 case of human papilloma virus infection (HPV) and 9 cases of cervix intraepithelial neoplasia grade I (CIN I). With a higher degree of severity, was found a case of high grade intraepithelial squamous lesion (HGISL) which is a cervix intraepithelial neoplasia grade II (CIN II). This confirms that the cytology is not a diagnostic medium and that this may underestimate the severity of the abnormality, which is evidenced in that 9 of 11 patients presented intraepithelial neoplasia in the biopsy result. The treatments established for each diagnosis correspond to that indicated in the technical standard for early detection of cervical cancer, nevertheless, the source does not allow to determine the type of treatment to 8 patients that specify with option "OTHER". It is also evidenced that 9 of the 11 women who received treatment achieved a negative control cytology for intraepithelial lesion or neoplasia. Meanwhile 1 of the 11 women who in her cytological screening was found ASCUS and the biopsy result was CIN I, presented ascus 6 months after treatment received; in this case it is impossible to advance in the analysis since the source document only records that the type of treatment was "OTRO" option. In 1 of the 11 samples of the subject population refers to a patient who did not perform the control cytology. The above allows to demonstrate that the treatments established were effective in this group of patients. It was also possible to determine important findings, that a higher prevalence of ASCUS results in control cytologiesduring the period from January to June 2014, was presented in the age range of 26 to 30 years,followed by the group of 20 to 25 years, which reveals the effectiveness of cervical cytology for timely detection of epithelial cell abnormalitiesand thus the early detection of cervical cancer. Of the 11 ASCUS results submitted from January to June 2014, 10 refer to women in annual screening and those who attend for the first time in the IPS. Finally, it could be appreciated that of 533 patients who entered the service of early detection of cervical cancer during the first half of 2014 at IPS ASMISALUD, 11 patients had atypical squamous cells of indeterminate meaning ASCUS representing 2.1% of the total patients. In the present work of degree, it was not possible to evidence that the cytology of first time is a directly related risk.