KOLPOSKOPİ YAPILAN KADINLARDA ANORMAL SERVİKAL SİTOLOJİ VE BİYOPSİ SONUÇLARINA GÖRE SAPTANAN HPV TİPLERİ

Year 2021, Volume: 1 Issue: 1 - June 2021, 20 - 27, 15.06.2021

Derya Sivri Aydın Ahmet Çetin

https://doi.org/10.54270/atljm.2021.3

Abstract

Amaç: Kolposkopi eşliğinde servikal biyopsi ve endoservikal küretaj (ECC) yapılan hastalarda patoloji ve referans smear sonuçlarına göre saptanan HPV tiplerini belirlemek.
Gereç ve Yöntem: Bu retrospektif vaka serisinde, jinekolojik onkoloji polikliniğinde kolposkopi yapılan 520 hasta çalışmaya alındı. Hastaların yaşı, HPV sonuçları, HPV tipleri, smear sonucu, kolposkopik biyopsi ve ECC sonuçlarına, yapılan eksizyon işleminin tipine ve patolojik sonuçlara hastane kayıt sisteminden ulaşıldı. Referans smear sonuçları ve kolposkopi eşliğinde servikal biyopsi ve ECC sonuçlarına göre saptanan HPV tipleri belirlendi.
Bulgular: Çalışmaya alınan hastaların 279’unda HPV pozitifti. 25.1% hastada HPV tip 16, 12.2% hastada tip 18, 47.0% (n=131) hastada diğer yüksek riskli HPV tipleri pozitifti. Diğer yüksek riskli HPV tiplerinden en sık HPV tip 39, 7.9% hastada izlendi. Referans smear sonucu 48.8% (n=239) hastada önemi belirlenemeyen atipik skuamöz hücreler, 23.9% (n=117) hastada düşük dereceli skuamöz intraepitelyal lezyon, 3.9% (n=19) hastada yüksek dereceli skuamöz intraepitelyal lezyon iken 23.5% (n=115) hastada smear sonucu normaldi. Smear sonucu anormal olan hastalarda yüksek riskli HPV enfeksiyonu sıklığı 68.3% idi ve en sık HPV tip 16 mevcuttu (25.1%). Punch biyopsi patolojisinde 48.4% hastada CIN (servikal intraepitelyal neoplazi)1, 8.1% hastada CIN2 veya CIN3, 30.4% hastada servisit ve 1.1% hastada skuamoz hücreli karsinom, 1% hastada normal patoloji saptandı. Biyopsi sonucu CIN2-3 veya skuamoz kanser olup, HPV tiplendirilmesi yapılan 71.4% hastada HPV tip 16 pozitifti.
Sonuç: Anormal sitoloji sonucu olan kadınların 68.3%’ünde yüksek riskli HPV enfeksiyonu saptadık. En sık görülen HPV genotipi tip 16 (25.1%) idi ve 12.2% hastada tip 18, 7.9% hastada tip 39 mevcuttu. Biyopsi sonucu CIN2 ve 3 ve skuamoz kanser olan 71.4% hastada HPV tip 16 pozitifti, tip 18 ve diğer yüksek riskli HPV tipleri kalan kısmından sorumluydu.

Keywords

İnsan papilloma virüsü, servikal intraepitelyal neoplazi, serviks kanseri, kolposkopi

References

• Bosch FX, Muñoz N. The viral etiology of cervical cancer. Virus Res (2002) 89:183–90.
• Bouvard V, Baan R, Straif K, et al. A review of human carcinogens – part B: biological agents. Lancet Oncol (2009) 10:321–2.
• IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Biological agents. Volume 100 B. A review of human carcinogens. IARC Monogr Eval Carcinog Risks Hum (2012) 100:1–441.
• Kjaer SK, van den Brule AJ, Paull G, et al. Type specific persistence of high risk human papillomavirus (HPV) as indicator of high grade cervical squamous intraepithelial lesions in young women: population based prospective follow up study. CJ BMJ. 2002;325(7364):572.
• Practice Bulletin No. 168: Cervical Cancer Screening and Prevention. Committee on Practice Bulletins—Gynecology. Obstet Gynecol. 2016;128(4):e111-130.
• Huh WK, Ault KA, Chelmow D, et al. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. J Low Genit Tract Dis. 2015 Apr;19(2):91-6.
• Gupta S, Palmer C, Bik EM, et al. SelfSampling for Human Papillomavirus Testing: Increased Cervical Cancer Screening Participation and Incorporation in International Screening Programs. Front Public Health. 2018 Apr 9;6:77.
• Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology Screening Guidelines for the Prevention and Early Detection of Cervical Cancer. J Low Genit Tract Dis. 2012 Jul;16(3):175-204. Review.
• González-Bosquet E, Esteva C, MuñozAlmagro C, Ferrer P, Pérez M, Lailla JM. Identification of vaccine human papillomavirus geno-types in squamous intraepithelial lesions (CIN2-3) Gynecol Oncol. 2008;111:9–12.
• Levert M, Clavel C, Graesslin O, et al. Human papillomavirus typing in routine cervical smears. Result from a series of 3778 patients. Gynecol Obstet Fertil. 2000;28:722–8.
• Cilingir IU, Bengisu E, Ağaçfidan A, et al. Microarray detection of human papilloma virus genotypes among Turkish women with abnormal cytology at a colposcopy unit. J Turk Ger Gynecol Assoc. 2013 Mar 1;14(1):23-7.
• Dursun P, Senger S, Arslan H, Kuşcu E, Ayhan A. Human papillomavirus (HPV) prevalence and types among Turkish women at a gynecology outpatient unit. BMC Infect Dis. 2009;9:191. doi: 10.1186/1471-2334-9-191.
• Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999;189(1):12.
• Ries LAG, Melbert D, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2004. National Cancer Institute; Bethesda, MD 2007.
• de Sanjose S, Quint WG, Alemany L, et al. Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study. Lancet Oncol. 2010;11:1048–1056.,
• Munoz N, Bosch FX, de Sanjose S, et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med. 2003;348:518–527.
• Li N, Franceschi S, Howell-Jones R, Snijders PJ, Clifford GM. Human papillomavirus type distribution in 30,848 invasive cervical cancers worldwide: Variation by geographical region, histological type and year of publication. Int J Cancer. 2011;128(4):927.
• Gök M, CoupéVM, Berkhof J, et al. HPV16 and increased risk of recurrence after treatment for CIN. Gynecol Oncol. 2007;104(2):273.
• Unnop Jaisamrarn, Xavier Castellsagué, Suzanne M. Garland, et al. Natural History of Progression of HPV Infection to Cervical Lesion or Clearance: Analysis of the Control Arm of the Large, Randomised PATRICIA Study HPV PATRICIA Study Group PLoS One. 2013; 8(11): e79260.
• Gage JC, Hanson VW, Abbey K, et al. ASCUS LSIL Triage Study (ALTS) Group. Number of cervical biyopsies and sensitivity of colposcopy. Obstet Gynecol. 2006;108(2):264.,
• Pretorius RG, Zhang WH, Belinson JL, et al. Colposcopically directed biopsy, random cervical biopsy, and endocervical curettage in the diagnosis of cervical intraepithelial neoplasia II or worse. Am J Obstet Gynecol. 2004;191(2):430.,
• Solomon D, Stoler M, Jeronimo J, Khan M, Castle P, Schiffman M. Diagnostic utility of endocervical curettage in women undergoing colposcopy for equivocal or low-grade cytologic abnormalities. Obstet Gynecol. 2007;110(2 Pt 1):288.
• Sellors JW, Sankaranarayanan R. Treatment of Cervical Intraepithelial Neoplasia by Loop Electrosurgical Excision Procedure (LEEP). Colposcopy and Treatment of Cervical Intraepithelial Neoplasia: A Beginner’s Manual. Lyon: World Health Organization; 2003. p. 103-10.
• Fuste P, Bellosillo B, Santamaria X, et al. HPV determination in the control after LEEP due to CIN II-III: prospective study and predictive model. Int J Gynecol Pathol. 2009;28:120-6.