Research Article
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Management of abnormal cytology results and correlation of cytopathologic results accompanied by colposcopy in our clinic.

Year 2017, Volume: 2 Issue: 3, 62 - 65, 01.12.2017
https://doi.org/10.25000/acem.342233

Abstract

Aim: Pap
smear test is a major screening test for early diagnosis and treatment of
cervix cancer. The aim of our study was to assess the value of colposcopy and
histopathologic examination in the management of patients with abnormal
cervical cytology by Bethesda Classification.

Methods: In
this study, we aimed to compare and evaluate the diagnosis of 12,381 cytology
material examined in our gynecology clinic during the years between 2014 and
2016 with their cytopathology results.

Results: 498 of 12,381 patients had abnormal cytological
findings (4.02%). The rates of Atypical Squamous Cells of Undetermined
Significance (ASC-US), Atypical Glandular Cells of Undetermined Significance
(AG-US), Low Grade Squamous Intraepithelial Lesions (LG-SIL) and High Grade
Squamous Intraepithelial Lesions (HG-SIL) were found to be 1.9%, 0.4%, 1% and %
0.1, respectively. Atypical squamous cell cannot exclude HSIL (ASC-H) rate were
found as % 0.4. The rate of abnormal cytology in cervical intraepithelial
lesions was 2.1. Positive predictive values of abnormal smear results were 21.7%
for ASC-US, 41.9% for LGSIL, 100% for HGSIL, 12.5% for AGUS and 50% for ASC-H.







Conclusion:
The Pap smear test is a cheap and easily applied screening test. Early
diagnosis of cervix cancer can be made by routine Pap smear testing. The
efficiency in clinical use of the cervical cytology screening test is
determined by biopsy verification. As the ratio of epithelial cell abnormality
is variable in different populations, the ASC (Atypical Squamous Cell) / SIL (Squamous
Intraepithelial Lesion) is a more definite variable to be used for quality
assurance.

References

  • 1. Aslan D. Contemporary problems in public medicine and approaches. Ankara Tabib Odası 2009; 25-45.
  • 2. Jemal A, Bray F, Center M, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011 Mar-Apr;61(2):69-90
  • 3. Ozgul N. Current state of cervical cancer and cervical cancer screening in Turkey. In: Tuncer AM, editor. Cancer control in Turkey. 1st ed. Ankara: 2007. pp. 349–58.
  • 4. Nanda K, McCrory DC, Myers ER, . Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systematic review. Ann Intern Med 2000 May 16;132(10):810-9
  • 5. Saslow D, Runowicz CD, Solomon D, Moscicki AB, Smith RA, Eyre HJ, et al; American Cancer Society guideline for the early detection of cervical neoplasia and cancer. CA Cancer J Clin 2002 Nov-Dec;52(6):342-62.
  • 6. Kuo DY, Goldberg GL. Screening of cervical cancer: where do we go from here? Cancer Invest 2003; 21(1): 157–161.doi:10.1081/CNV-120016410.
  • 7. Benedet J, Matisic J, Bertrand M. An analysis of 84,244 patients from the British Columbia cytology–colposcopy program: Gynecologic Oncology 2004;92(3):127–134.
  • 8. Rock JA, Jones HW: Te Linde’s Operative Gynecology, Dokuzuncu Basım, Lippincott Williams & Wilkins Yayınları , Servikal Kanser Prekürsörleri ve Yönetimi, Bölüm 45-46; 1231-1254.
  • 9. Zweizig S, Noller K, Reale F, Collis S, Resseguie L. Neoplasia associated with atypical glandular cells of undetermined significance on cervical cytology. Gynecol Oncol. 1997 May;65(2):314-8.
  • 10. Koutsky LA, Holmes KK, Critchlow CW, Stevens CE, Paavonen J, Beckmann AM, et al. A cohort study of the risk of cervical intraepithelial neoplasia grade 2 or 3 in relation to papillomavirus infection. N Engl J Med. 1992 Oct 29;327(18):1272-8.
  • 11. Human papillomavirus testing for triage of women with cytologic evidence of low-grade squamous intraepithelial lesions: baseline data from a randomized trial. The Atypical Squamous Cells of Undetermined Significance/ Low-Grade Squamous Intraepithelial Lesions Triage Study (ALTS) Group. J Natl Cancer Inst. 2000 Mar 1;92(5):397-402.
  • 12. ACOG Practice Bulletin on Clinical Management Guidelines for Obstetricians-Gynecologists. Management of abnormal cervical cytology and histology. In: ACOG Women’s Health Care Physician’s Compendium of Selected Publications, practice bulletin number 66, September 2005.Washington (DC):ACOG Distribution Center, 2006; 603-22.
  • 13. Dısaıa JP, Creasman TW: Klinik Jinekolojik Onkoloji, altıncı baskı, 2003; 3-61, 633.
  • 14. Kaya M. ‘’Cervical cancer’’ with public health approach. HUKSAM Yayinlari 2009; 34-73.
  • 15. Turkistanlı EC, Sogukpinar N, Saydam BK, Aydemir G. Cervical cancer prevention and early detection – the role of nurses and midwives. Acian Pac J Cancer Prev 2003; 4(1): 15-21.
  • 16. Soler ME, Gaffikin L, Blumenthal PD. Cervical cancer screening in developing countries. Prim Care Update Ob Gyns 2000; 7(3): 118-23.
  • 17. Waxman AG. Guidelines for cervical cancer screening, history and scientific rationale. Clin Obstet Gynecol 2005; 48(1): 77-97.
  • 18. Saraiya UB. Preventable but not prevented: the reality of cervical cancer. J Obstetr Gynecol Res 2003; 29(1): 351-9.
  • 19. Ayhan A, Durukan T, Gunalp S. Basic knowledge of obstetrics and gynecology. Gunes Medical Publishing. 2 ed. Ankara 2008; 1027
  • 20. American College of Obstetricians and Gynecologists. ACOG practice bulletin. Cervical Cytology screening. Number 45, August 2003. Int J Gynaecol Obstet 2003; 83(2): 237-47.
  • 21. Gokaslan H, Uyar EE. Screening cervical cancer with Pap smear. Turk Aile Hek Derg 2004; 8(3): 105-10
  • 22. Biedka M, Makarewicz R, Kopczyńska E, Marszałek A, Goralewska A, Kardymowicz H. Angiogenesis and lymphangiogenesis as prognostic factors after therapy in patients with cervical cancer. Contemp Oncol (Pozn) 2012; 16(1): 6-11.
  • 23. Belinson J, Qiao YL, Pretorius R, Zhang WH, Elson P, Li L,, et al. Shanxi province cervical cancer screening study: a cross-sectional comperative trial of multiple techniques to detect cervical neoplasia. Gynecol Oncol 2001; 83(3): 439-44.
  • 24. Celik C, Gezginc K, Toy H, Findik S, Yilmaz O. A comparison of liquid-based cytology with conventional cytology. Int J Gynecol Obstet 2008; 100(2): 163-6.
  • 25. Atilgan Remzi, Celik Aygen, Boztosun Abdullah, Ilter Erdin, Yalta Tulin, Ozercan Resat. "Evaluation of cervical cytological abnormalities in Turkish population." Indian Journal of Pathology and Microbiology 2012;55(1): 52-55.
  • 26. Keskin H. L, Seçen E. İ, Taş E, Kaya S, & Avşar A. F. Servikal smear sitolojisi ile kolposkopi eşliğinde servikal biyopsi korelasyonu.Türk Jinekolojik Onkoloji Dergisi, 2011. 3, 71-75.
  • 27. Türkmen İlknur Çetinaslan, Başsüllü Nuray, Korkmaz Pınar, Güvenc Banu, Baykal Cem Murat, Güdücü Nilgün et al. "Patients with Epithelial Cell Abnormality in PAP Smears: Correlation of Results with Follow-Up Smears and Cervical Biopsies/PAP Smearde Epitel Hücre Atipisi Saptanan Hastalar: Sonuçların Takip Smear ve Servikal Biyopsi ile Uyumları." Turkish Journal of Pathology 2013:29(3); 179-184.

Kliniğimizdeki anormal servikal smear sonuçlarının yönetimi ve kolposkopi eşliğinde alınan sitopatoloji sonuçlarının korelasyonu

Year 2017, Volume: 2 Issue: 3, 62 - 65, 01.12.2017
https://doi.org/10.25000/acem.342233

Abstract

Amaç: Pap smear testi serviks kanserinin
erken tanı ve tedavisinde çok önemli bir tarama yöntemidir. Bu çalışmanın
amacı, smear testinde anormallik saptanan olguların yönetiminde kolposkopi ve
patolojik incelemenin öneminin belirlenebilmesidir.



Yöntemler: Bu çalışmada
2014-2016 yılları arasında Düzce Atatürk Devlet Hastanesi Jinekoloji
Polikliniği’ne başvuran 12.381 hastanın Bethesda sınıflamasına göre Pap Smear testi
sonuçları ve kolposkopi eşliğinde alınan sitopatoloji sonuçları
değerlendirilmiş ve karşılaştırılmıştır.


Bulgular: 12.381 olgunun 498’inde anormal sitolojik bulgular saptandı (% 4,02).
Anormal sitolojilerin içerisinde önemi bilinmeyen hücreler (ASCUS) % 1,9, Atipik
Glanduler Hücreler (AGUS) % 0,4, Düşük Dereceli Skuamöz İntraepitelyal Lezyon
(LGSIL) %1, Yüksek Dereceli İntraepitelyal Lezyon (HGSIL) % 0,1, Atipik Skuamöz
Hücrelerin Dışlanmadığı Grup (ASC-H) % 0,4 olarak saptanırken, anormal
sitolojilerin servikal intraepitelyal lezyonlara oranı 2,1 olarak saptandı. Pap
Smear’de anormal sitolojik bulgu saptanan olguların pozitif öngörü değerleri
ASCUS için %21,7, LGSIL için %41,9, HGSIL için %100, AGUS için %12,5 ve ASC-H için
%50 olarak hesaplandı.


Sonuç: Pap Smear testi, ucuz ve kolay bir yöntemdir. Serviks kanserinin erken
tanısı Pap smear testi sayesinde mümkündür. Servikal sitolojinin klinik
uygulamalarda güvenilir şekilde kullanımı ise biyopsi doğrulaması ile
mümkündür. Farklı toplumlarda epitel hücre anomalisi oranı değişken olabildiği
için atipik skuamöz hücre
 (ASH) / servikal
skuamöz intraepitelyal lezyon (SIL) oranı kalite yöntemi açısından daha net bir
veri olarak değerlendirilmektedir.
  

References

  • 1. Aslan D. Contemporary problems in public medicine and approaches. Ankara Tabib Odası 2009; 25-45.
  • 2. Jemal A, Bray F, Center M, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011 Mar-Apr;61(2):69-90
  • 3. Ozgul N. Current state of cervical cancer and cervical cancer screening in Turkey. In: Tuncer AM, editor. Cancer control in Turkey. 1st ed. Ankara: 2007. pp. 349–58.
  • 4. Nanda K, McCrory DC, Myers ER, . Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systematic review. Ann Intern Med 2000 May 16;132(10):810-9
  • 5. Saslow D, Runowicz CD, Solomon D, Moscicki AB, Smith RA, Eyre HJ, et al; American Cancer Society guideline for the early detection of cervical neoplasia and cancer. CA Cancer J Clin 2002 Nov-Dec;52(6):342-62.
  • 6. Kuo DY, Goldberg GL. Screening of cervical cancer: where do we go from here? Cancer Invest 2003; 21(1): 157–161.doi:10.1081/CNV-120016410.
  • 7. Benedet J, Matisic J, Bertrand M. An analysis of 84,244 patients from the British Columbia cytology–colposcopy program: Gynecologic Oncology 2004;92(3):127–134.
  • 8. Rock JA, Jones HW: Te Linde’s Operative Gynecology, Dokuzuncu Basım, Lippincott Williams & Wilkins Yayınları , Servikal Kanser Prekürsörleri ve Yönetimi, Bölüm 45-46; 1231-1254.
  • 9. Zweizig S, Noller K, Reale F, Collis S, Resseguie L. Neoplasia associated with atypical glandular cells of undetermined significance on cervical cytology. Gynecol Oncol. 1997 May;65(2):314-8.
  • 10. Koutsky LA, Holmes KK, Critchlow CW, Stevens CE, Paavonen J, Beckmann AM, et al. A cohort study of the risk of cervical intraepithelial neoplasia grade 2 or 3 in relation to papillomavirus infection. N Engl J Med. 1992 Oct 29;327(18):1272-8.
  • 11. Human papillomavirus testing for triage of women with cytologic evidence of low-grade squamous intraepithelial lesions: baseline data from a randomized trial. The Atypical Squamous Cells of Undetermined Significance/ Low-Grade Squamous Intraepithelial Lesions Triage Study (ALTS) Group. J Natl Cancer Inst. 2000 Mar 1;92(5):397-402.
  • 12. ACOG Practice Bulletin on Clinical Management Guidelines for Obstetricians-Gynecologists. Management of abnormal cervical cytology and histology. In: ACOG Women’s Health Care Physician’s Compendium of Selected Publications, practice bulletin number 66, September 2005.Washington (DC):ACOG Distribution Center, 2006; 603-22.
  • 13. Dısaıa JP, Creasman TW: Klinik Jinekolojik Onkoloji, altıncı baskı, 2003; 3-61, 633.
  • 14. Kaya M. ‘’Cervical cancer’’ with public health approach. HUKSAM Yayinlari 2009; 34-73.
  • 15. Turkistanlı EC, Sogukpinar N, Saydam BK, Aydemir G. Cervical cancer prevention and early detection – the role of nurses and midwives. Acian Pac J Cancer Prev 2003; 4(1): 15-21.
  • 16. Soler ME, Gaffikin L, Blumenthal PD. Cervical cancer screening in developing countries. Prim Care Update Ob Gyns 2000; 7(3): 118-23.
  • 17. Waxman AG. Guidelines for cervical cancer screening, history and scientific rationale. Clin Obstet Gynecol 2005; 48(1): 77-97.
  • 18. Saraiya UB. Preventable but not prevented: the reality of cervical cancer. J Obstetr Gynecol Res 2003; 29(1): 351-9.
  • 19. Ayhan A, Durukan T, Gunalp S. Basic knowledge of obstetrics and gynecology. Gunes Medical Publishing. 2 ed. Ankara 2008; 1027
  • 20. American College of Obstetricians and Gynecologists. ACOG practice bulletin. Cervical Cytology screening. Number 45, August 2003. Int J Gynaecol Obstet 2003; 83(2): 237-47.
  • 21. Gokaslan H, Uyar EE. Screening cervical cancer with Pap smear. Turk Aile Hek Derg 2004; 8(3): 105-10
  • 22. Biedka M, Makarewicz R, Kopczyńska E, Marszałek A, Goralewska A, Kardymowicz H. Angiogenesis and lymphangiogenesis as prognostic factors after therapy in patients with cervical cancer. Contemp Oncol (Pozn) 2012; 16(1): 6-11.
  • 23. Belinson J, Qiao YL, Pretorius R, Zhang WH, Elson P, Li L,, et al. Shanxi province cervical cancer screening study: a cross-sectional comperative trial of multiple techniques to detect cervical neoplasia. Gynecol Oncol 2001; 83(3): 439-44.
  • 24. Celik C, Gezginc K, Toy H, Findik S, Yilmaz O. A comparison of liquid-based cytology with conventional cytology. Int J Gynecol Obstet 2008; 100(2): 163-6.
  • 25. Atilgan Remzi, Celik Aygen, Boztosun Abdullah, Ilter Erdin, Yalta Tulin, Ozercan Resat. "Evaluation of cervical cytological abnormalities in Turkish population." Indian Journal of Pathology and Microbiology 2012;55(1): 52-55.
  • 26. Keskin H. L, Seçen E. İ, Taş E, Kaya S, & Avşar A. F. Servikal smear sitolojisi ile kolposkopi eşliğinde servikal biyopsi korelasyonu.Türk Jinekolojik Onkoloji Dergisi, 2011. 3, 71-75.
  • 27. Türkmen İlknur Çetinaslan, Başsüllü Nuray, Korkmaz Pınar, Güvenc Banu, Baykal Cem Murat, Güdücü Nilgün et al. "Patients with Epithelial Cell Abnormality in PAP Smears: Correlation of Results with Follow-Up Smears and Cervical Biopsies/PAP Smearde Epitel Hücre Atipisi Saptanan Hastalar: Sonuçların Takip Smear ve Servikal Biyopsi ile Uyumları." Turkish Journal of Pathology 2013:29(3); 179-184.
There are 27 citations in total.

Details

Subjects Surgery
Journal Section Original Research
Authors

Ozan Doğan

Ahmet Yıldız This is me

Çiğdem Pulatoğlu

Publication Date December 1, 2017
Published in Issue Year 2017 Volume: 2 Issue: 3

Cite

Vancouver Doğan O, Yıldız A, Pulatoğlu Ç. Management of abnormal cytology results and correlation of cytopathologic results accompanied by colposcopy in our clinic. Arch Clin Exp Med. 2017;2(3):62-5.