Ghid de diagnostic si tratament al cancerului de col uterin
Ghid de diagnostic si tratament al cancerului de col uterin
Ghid de diagnostic si tratament al cancerului de col uterin
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
intraepiteli<strong>al</strong>a <strong>de</strong> grad redus)<br />
HGSIL : High Gra<strong>de</strong> Scuamous Intraepitheli<strong>al</strong> Le<strong>si</strong>on (leziune<br />
spinocelulara<br />
intraepiteli<strong>al</strong>a <strong>de</strong> grad ridicat)<br />
atipice)<br />
*ST*<br />
AGC :<br />
Atypic<strong>al</strong> Glandular Cells (celule glandulare<br />
Comentarii la Sistemul Bethesda, 2001.<br />
1. Formularea "Negativ pentru leziuni intraepiteli<strong>al</strong>e sau<br />
m<strong>al</strong>ignitate" a inlocuit vechile formulari: "in limite norm<strong>al</strong>e" <strong>si</strong><br />
"modificari celulare benigne". Descrirea citologica trebuie sa<br />
specifice prezenta sau absenta anom<strong>al</strong>iilor celulare epiteli<strong>al</strong>e,<br />
originea lor (scuamoasa sau glandulara), precum <strong>si</strong> prezenta unor<br />
microorganisme ce sugereaza un potenti<strong>al</strong> infectios (Trichomonas,<br />
Candida, Actinomyces).<br />
2. Categoria ASC (Atypic<strong>al</strong> Scuamous Cells) a fost divizata in<br />
doua categorii: una cu semnificatie necunoscuta (ASC-US) <strong>si</strong> <strong>al</strong>ta<br />
in care leziunile <strong>de</strong> grad in<strong>al</strong>t trebuie excluse (ASC-H). V<strong>al</strong>oarea<br />
predictiva pozitiva a ASC-H este mult mai mare <strong>de</strong>cat a ASC-US,<br />
24-40 % din ASC-H fiind <strong>de</strong> fapt CIN III <strong>si</strong> CIN II.<br />
3. Formularea AGUS a fost inlocuita cu AGC.<br />
Standard<br />
Sistemul Bethesda (TBS) <strong>si</strong> Papani<strong>col</strong>au.<br />
Optiuni<br />
Sistemul <strong>de</strong> cla<strong>si</strong>ficare Papani<strong>col</strong>au a citologiei cervic<strong>al</strong>e a<br />
fost inlocuit <strong>de</strong> <strong>si</strong>stemul Bethesda, introdus in 1988. La ora<br />
actu<strong>al</strong>a acest <strong>si</strong>stem nu este inca unanim folo<strong>si</strong>t <strong>de</strong> catre<br />
citologi <strong>si</strong> gine<strong>col</strong>ogi, dar are o larga acceptabilitate <strong>si</strong> o<br />
progre<strong>si</strong>va extin<strong>de</strong>re.<br />
Sistemul CIN/ Displazie.<br />
Pacientelor cu citologie anorm<strong>al</strong>a, fara leziune macroscopica<br />
cervic<strong>al</strong>a li se recomanda examinare <strong>col</strong>poscopica <strong>si</strong> biop<strong>si</strong>e. Daca<br />
examenul <strong>col</strong>poscopic nu evi<strong>de</strong>ntiaza modificari patologice sau<br />
daca nu se vizu<strong>al</strong>izeaza intreaga jonctiune scuamo-cilindrica -<br />
pacientelor cu citologie anorm<strong>al</strong>a li se efectueaza un chiuretaj<br />
endocervic<strong>al</strong>. Daca nici chiuretajul endocervic<strong>al</strong> nu evi<strong>de</strong>ntiaza o<br />
leziune care sa explice citologia anorm<strong>al</strong>a, se recurge la o<br />
conizatie, care are acuratete superioara chuiretajului.<br />
2.1.3. Colposcopia <strong>si</strong> biop<strong>si</strong>a<br />
Colposcopia poate ev<strong>al</strong>ua in mod a<strong>de</strong>cvat exocervixul <strong>si</strong><br />
portiunea endocervic<strong>al</strong>a adiacenta zonei <strong>de</strong> tranzitie scuamocilindrice.<br />
Biop<strong>si</strong>a ghidata <strong>col</strong>poscopic <strong>si</strong> chiuretajul<br />
endocervic<strong>al</strong> ofera un <strong>diagnostic</strong> <strong>si</strong>gur la majoritatea<br />
pacientelor.<br />
La unele paciente <strong>col</strong>poscopia nu este suficienta. Se<br />
con<strong>si</strong><strong>de</strong>ra ina<strong>de</strong>cvata, daca:<br />
1. zona <strong>de</strong> tranzitie nu se vizu<strong>al</strong>izeaza complet<br />
2. leziunea vizibila se extin<strong>de</strong> in can<strong>al</strong>ul endocervic<strong>al</strong><br />
3. chiuretajul endocervic<strong>al</strong> evi<strong>de</strong>ntiaza fragmente <strong>de</strong><br />
displazie<br />
4. exista discordanta intre diversele meto<strong>de</strong> <strong>de</strong> <strong>diagnostic</strong>.
Change language