Autocolheita vaginal versus colheita por profissional de saúde para rastreio do cancro do colo do útero: uma revisão sistemática com meta-análise de precisão e aceitabilidade
DOI:
https://doi.org/10.32385/rpmgf.v41i1.13988Keywords:
Papilomavírus humano, Cancro do colo do útero, Autocolheita, Rastreio, Teste diagnóstico, AceitabilidadeAbstract
Introdução: Estratégias de autocolheita de DNA do papilomavírus humano (HPV) mostraram-se promissoras na deteção de doença; no entanto, não é clara a sua real potencialidade ou aceitabilidade pelas mulheres.
Objetivos: Como objetivo principal pretendeu-se determinar a precisão da deteção, estudo de não inferioridade, de HPV em amostras de autocolheita, comparativamente às colhidas por profissional de saúde. Secundariamente, pretendeu-se avaliar a aceitabilidade pelas mulheres.
Métodos: Realizou-se uma pesquisa sistemática maioritariamente em bases de dados eletrónicas (MEDLINE, CENTRAL e Scopus). Foram incluídos estudos que compararam os dois métodos de rastreio. A seleção dos estudos e extração de dados foi feita por dois autores de forma independente. Utilizou-se o QUADAS2 Tool e Cochrane Risk of Bias Tool para avaliar o risco de viés. A sensibilidade e a especificidade dos testes foram estimadas e elaboradas curvas SROC, utilizando o RevMan v. 5.4. e MetaDisc para a análise de dados. Foi também realizada uma análise de subgrupo e de sensibilidade.
Resultados: Foram incluídos 67 artigos (precisão 47 e aceitabilidade 36) com uma amostra total de 18.615 mulheres, com idades entre 15-80 anos. Demonstrou-se uma sensibilidade de 86,4% e uma especificidade de 91.8% Na análise de subgrupos não foram detetadas diferenças significativas relativas ao tipo de teste, dispositivo de autocolheita e respetivo transporte ou prevalência de HPV. Relativamente à aceitabilidade, as mulheres consideram a autocolheita fácil, confortável, privada e não constrangedora. 62,8% prefere a autocolheita.
Conclusão: Esta revisão sistemática e meta-análise demonstrou uma taxa de deteção de HPV não inferior à colheita por profissional de saúde e revelou ser um método com boa aceitabilidade pela maioria das mulheres. No entanto, ainda há poucas evidências sobre a sua viabilidade e aplicabilidade, pelo que futuramente a avaliação de custo-efetividade deste tipo de rastreio deve ser realizada a nível nacional e internacional.
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