[Cytological diagnosis of atypical squamous cells: a critical evaluation of diagnostic guidelines].
OBJECTIVE
to identify valid guidelines for the approach of women with cytopathological diagnosis of undetermined significance atypias in squamous cells (ASC), discussing its applicability to the Brazilian scenario.


METHODS
an electronic search of publications at PubMed, National Guidelines Clearinghouse and Scholar Google was carried out, as well as a manual search of references from the texts found. The guidelines identified, and specifically related to the theme, were evaluated according to its validity and the recommendations were criticized and summarized.


RESULTS
guidelines for the United Kingdom, France, Australia, the USA and New Zealand have been considered as valid. These documents recommend repeating the cytology in six or twelve months, in ASCs of undetermined significance (ASC-US) before referring to colposcopy, and immediate referral to colposcopy in ASCs, when it is not possible to disregard high degree lesions (ASC-H). We have also found valid colposcopy recommendations for women with ASC-US in special situations (immune deficient women requiring specialist assistance) and the use of oncogenic HPV test, which, when present in women over 20, should motivate referral to colposcopy.


CONCLUSIONS
the clinical guidelines recommended for the Programa Nacional de Controle do Cancer do Colo do Utero in Brazil can be improved with the referral to colposcopy in special situations (immune deficient women requiring specialist assistance), the use of test for the detection of oncogenic HPV in women over 20 (when present, refer to colposcopy), the investigation of vaginal lesions, the use of estrogens before the colposcopy in post-menopausal women, and disregard biopsy in case of slighter alterations.
Russomano
Fábio
F
Setor de Patologia Cervical e Colposcopia, Instituto Fernandes Figueira, FIOCRUZ, Rio de Janeiro, RJ, Brasil.
Monteiro
Aparecida Cristina Sampaio
AC
Mousinho
Roberta Osta
RO
D002584:Cervix Uteri / Q000473:pathology*; D003663:Decision Trees; D005260:Female; D006801:Humans; D017410:Practice Guidelines as Topic; D002583:Uterine Cervical Neoplasms / Q000473:pathology*