Case Report
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HUMAN PAPİLLOMA VİRUS TARAMA TESTİ POZİTİF SERVİKAL SİTOLOJİK TARAMASI NEGATİF VEYA ÖNEMİ BELİRLENEMEYEN ATİPİK SQUAMOZ HÜCRE SAPTANAN HASTALARIN REİD İNDEKSİ KULLANILARAK SINIFLANDIRILMIŞ KOLPOSKOPİK BULGULARININ HİSTOPATOLOJİK SONUÇLARLA KARŞILAŞTIRILMASI Comparison of Colposcopic Findings Using Reid Index of Patients with Cervical Cytological Screening Negative Atypical Squamous Cell Undetermined Significance, Positive Human Papilloma Virus Screening Test with and Histopathological Results

Year 2019, Volume: 9 Issue: 4, 141 - 150, 27.12.2019

Abstract

ÖZET
Amaç: Jinekolojik kanserler arasında tarama testi olan tek malignite serviks kanseridir. Tarama testi olarak smear ile sitoloji
bakılması ve Hpv tiplendirilmesi kullanılmaktadır. Serviks kanserlerinin %90’dan fazlasında Hpv pozitifliği saptanmaktadır.
Çalışmamızda amaç servikal sitolojisi negatif veya ASCUS olarak yorumlanan, HPV DNA taraması pozitif olan hastaların kolposkopi
sonuçlarını Reid indeksi yardımıyla yorumlayıp, elde edilen sonuçların histopatoloji ile karşılaştırılması ve tek başına
HPV pozitifliğinin preinvaziv veya invaziv hastalığı tanımlayıp kolposkopiye refere edilmesinin gerekliliğini araştırmaktır.
Gereç ve Yöntemler: 2015-2017 yılları arasında SBÜ İstanbul Eğitim ve Araştırma Hastanesinde sitolojisi negatif veya ASCUS
olan, HPV DNA sonucu pozitif olan 30-65 yaş arası hastalar çalışmaya dahil edildi. Yapılmış kolposkopilerin kolpofotoğrafları
ve histopatolojik biyopsi sonuçları hasta kayıt sisteminden çıkarıldı. Kolpofotoğraflar Reid indeksine göre sınıflandırılıp,
histopatolojik sonuçlarla kıyaslandı. Reid İndeks skorlaması kullanılarak displazi derecesinin tahmini LGSIL, HGSIL ve
invaziv hastalık şeklinde sınıflandırıldı.
Bulgular: Sitolojisi normal veya ASCUS, hr-HPV DNA (yüksek risk HPV DNA) sonucu pozitif olan 150 hasta taranmıştır. Kadınların
yaş ortalaması 42.9 ± 8.5 idi. Hastaların %88.7’i sitoloji normal/HPV pozitif, %11.3’ü ASCUS/HPV pozitifti. Sitolojisi
normal olan grupta %59.3 oranında HPV 16, 18 pozitifliği izlendi. ASCUS grubunda %5.3 oranında HPV 16 ve/veya 18 pozitifliği
tespit edildi. Diğer hr-HPV pozitifliği %3.3 olarak görüldü. Reid indeks skalasına göre 0-2 puan alan hasta oranı %70,
3-5 puan %20.7, 6-8 puan %8.7 olarak hesaplanmıştır. Histopatolojik sonuçlara baktığımızda %82 normal, %10.7 HGSIL,
%1.3 LGSIL, %1.3 servikal karsinom olarak gözlemlenmiştir.
Sonuç: Reid indeksi kullanılarak yapılan displazi tahmini ile kesin histoloji sonuçlarındaki displazi tahmini arasında uyum
vardır. Kolposkopi bir sekonder tanı testi olarak anormal smear sonucu olan olgularda serviksteki en şüpheli alanı belirlemede
ve lezyondaki displazi derecesini tahmin etmede yararlıdır. Çalışmamız sitoloji sonucunun normal olduğu hastalarda
yüksek oranda servikal displazi, hatta kanser vakalarının HPV DNA ile yakalanabildiğini göstermektedir. Kolposkopinin belli
kriterleri olan bir skorlama sistemi ile yapıldığı taktirde histopatoloji sonuçları ile daha yüksek korelasyon gösterdiği görülmektedir.
Anahtar kelimeler: Serviks kanseri; Kolposkopi; Reid indeksi; Histopatoloji; Smear
ABSTRACT
Objective: Cervical cancer is the only malignancy having screening test among gynecologic cancers. Cervical cytology and
Hpv typing are used as screening tests. Hpv positivity is detected in more than 90% of cervical cancers. The aim of our
study is to evaluate the colposcopy results of patients with negative cervical cytology or ASCUS and positive HPV DNA
screening with the help of Reid index, to compare the results with histopathology and to identify the HPV positivity alone
and to refer to colposcopy.
Material and Methods: Patients between 30-65 years of age who had negative cytology or ASCUS with positive HPV DNA
result at SBU Istanbul Training and Research Hospital between 2015-2017 were included in the study. Colpophotograph
and histopathological biopsy results of colposcopies were collected from the patient registry system. Colpophotographs
were classified according to Reid index and compared with histopathological results. Estimation of dysplasia level by using
Reid Index scoring was classified as LGSIL, HGSIL and invasive disease.
Results: 150 patients with normal cytology or ASCUS and with positive hr-HPV DNA (high risk HPV DNA) results were
analyzed. The mean age of the women was 42.9 ± 8.5 years. Cytology was normal / HPV positive in 88.7% and ASCUS
/ HPV positive in 11.3%. HPV 16, 18 positivity was observed in 59.3% of the group with normal cytology. HPV 16 and /
or 18 positivity was detected in 5.3% of ASCUS group. The other hr-HPV positivity was 3.3%. The rate of patients who
scored 0-2 points according to the reid index scale was calculated as 70%, 3-5 points as 20.7%, 6-8 points as 8.7%. When
histopathological results were evaluated, 82% normal, 10.7% HGSIL, 1.3% LGSIL, 1.3% cervical carcinoma were observed.
Conclusion: There is a correlation between the prediction of dysplasia using the reid index and the prediction of dysplasia
in definite histology results. Colposcopy is useful as a secondary diagnostic test in determining the most suspicious area
of the cervix and predicting the degree of dysplasia in the lesion in patients with abnormal smear results. Our study
shows that cervical dysplasia and even cancer cases can be detected by HPV DNA in patients with normal cytology results.
Colposcopy showed a higher correlation with histopathological results if performed with a scoring system with certain
criteria.
Key words: Cervix cancer; Colposcopy; Reid index; Histopathology; Smear

References

  • 1. T.S.B.T.K.K. Programı, “6 TÜRKİYE KANSER KONTROL PLANI 2013 - 2018,” 2015. 2. Bruni L, Barrionuevo-Rosas L, Albero G, Aldea M, Serrano B, Valencia S, et al., “ICO Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in[Botswana],” Summary Report, 2014. . 3. Kitchener H. C, Castle P. E, and Cox J. T, “Achievements and limitations of cervical cytology screening.,” Vaccine, 2006 Aug 31;24 Suppl 3:S3/63-70. 4. “ACOG practice bulletin No. 99: Management of abnormal cervical cytology and histology,” Obstetrics and Gynecology, vol. 112, no. 6. pp. 1419–1444, 2008. 5. Wright T. C, Massad L. S, Dunton C. J, Spitzer M, Wilkinson E. J, and Solomon D. “2006 Consensus guidelines for the management of women with abnormal cervical screening tests,” in Journal of Lower Genital Tract Disease, 2007, vol. 11, no. 4, pp. 201–222. 6. Huh WK, Ault KA, Chelmow D, Davey DD, Goulart RA, Garcia FA, et al. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. Gynecol Oncol 2015;136:178-82. 7. Burghardt E., Histopathologic basis of colposcopy. İn: Colposcopy Cervical Pathology Textbook and Atlas, 2nd ed. New York, NY: : Georg Thieme Verlag, 1991. 8. Davey E1, Barratt A, Irwig L, Chan SF, Macaskill P, Mannes P et al., “Effect of study design and quality on unsatisfactory rates, cytology classifications, and accuracy in liquid-based versus conventional cervical cytology: A systematic review,” Lancet, Lancet. 2006 Jan 14;367(9505):122-32. 9. Lowy D. R, Solomon D, Hildesheim A, Schiller J. T, and Schiffman M. “Human papillomavirus infection and the primary and secondary prevention of cervical cancer,” Cancer, 2008 Oct 1;113(7 Suppl):1980-93. doi: 10.1002/cncr.23704. 10. Spitzer M, Apgar B. S, Brotzman G. L, and Krumholz B, “Residency training in colposcopy: a survey of program directors in obstetrics and gynecology and family practice.,” Am. J. Obstet. Gynecol., 2001. 2001 Aug;185(2):507-13. 11. Özsoy AZ, Çetin M, Çetin A. “Vajinal Smear İncelemesinde Skuamöz İntraepitelyal Lezyon Saptanan Olguların Kolposkopik Klinik ve Histopatolojik Bulgularının İlişkisinin İncelenmesi,” Gaziosmanpaşa Üniversitesi Tıp Fak. Derg., no. 3, pp. 208–217, 2015. 12. Mitchell M. F, Schottenfeld D, Tortolero-Luna G, Cantor S. B, and Richards-Kortum R. “Colposcopy for the diagnosis of squamous intraepithelial lesions: A meta-analysis,” Obstet. Gynecol., Apr;91(4):626-31. 13. Mousavi A. S, Fakour F, Gilani M. M, Behtash N, Ghaemmaghami F, and Zarchi M. K. “A prospective study to evaluate the correlation between reid colposcopic index impression and biopsy histology,” J. Low. Genit. Tract Dis., 2007. Jul;11(3):147-50. 14. Cantor SB1, Cárdenas-Turanzas M, Cox DD, Atkinson EN, Nogueras-Gonzalez GM, Beck JR. Et al.“Accurary of colposcopy in the diagnostic setting compared with the screening setting,” Obs. Gynecol, 2008 Jan;111(1):7-14. doi: 10.1097/01.AOG.0000295870.67752.b4. 15. Jovanović AM1, Dikic SD, Jovanovic V, Zamurovic M, Nikolic B, Krsic V et el. “Correlation of human papilloma virus infection with cytology, colposcopy and histopathological examination of the bioptic tissue in low- and high-grade intraepithelial lesions,” Eur J Gynaecol Oncol., 2012;33(5):512-6. 16. Nash JD, Burke TW, Hoskins WJ. “Biologic course of cervical human papillomavirus infection,” Obs. Gynecol, 1987 Feb;69(2):160-2. 17. Arbyn M, Dillner J, Van Ranst M, Buntinx F, Martin-Hirsch P, Paraskevaidis E. “Re: Have we resolved how to triage equivocal cervical cytology (multiple letters) [1],” Journal of the National Cancer Institute. 2004. Sep 15;96(18):1401-2; author reply 1402. 18. Scheungraber C1, Glutig K, Fechtel B, Kuehne-Heid R, Duerst M, Schneider A. “Inner border-A specific and significant colposcopic sign for moderate or severe dysplasia (Cervical Intraepithelial Neoplasia 2 or 3),” J. Low. Genit. Tract Dis., 2009. Jan;13(1):1-4. doi: 10.1097/LGT.0b013e31817ff92a. KARİMOVA ve ark. Reid İndeksi ve Histopatoloji Bozok Tıp Derg 2019;9(4):141-150 Bozok Med J 2019;9(4):141-150
Year 2019, Volume: 9 Issue: 4, 141 - 150, 27.12.2019

Abstract

References

  • 1. T.S.B.T.K.K. Programı, “6 TÜRKİYE KANSER KONTROL PLANI 2013 - 2018,” 2015. 2. Bruni L, Barrionuevo-Rosas L, Albero G, Aldea M, Serrano B, Valencia S, et al., “ICO Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in[Botswana],” Summary Report, 2014. . 3. Kitchener H. C, Castle P. E, and Cox J. T, “Achievements and limitations of cervical cytology screening.,” Vaccine, 2006 Aug 31;24 Suppl 3:S3/63-70. 4. “ACOG practice bulletin No. 99: Management of abnormal cervical cytology and histology,” Obstetrics and Gynecology, vol. 112, no. 6. pp. 1419–1444, 2008. 5. Wright T. C, Massad L. S, Dunton C. J, Spitzer M, Wilkinson E. J, and Solomon D. “2006 Consensus guidelines for the management of women with abnormal cervical screening tests,” in Journal of Lower Genital Tract Disease, 2007, vol. 11, no. 4, pp. 201–222. 6. Huh WK, Ault KA, Chelmow D, Davey DD, Goulart RA, Garcia FA, et al. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. Gynecol Oncol 2015;136:178-82. 7. Burghardt E., Histopathologic basis of colposcopy. İn: Colposcopy Cervical Pathology Textbook and Atlas, 2nd ed. New York, NY: : Georg Thieme Verlag, 1991. 8. Davey E1, Barratt A, Irwig L, Chan SF, Macaskill P, Mannes P et al., “Effect of study design and quality on unsatisfactory rates, cytology classifications, and accuracy in liquid-based versus conventional cervical cytology: A systematic review,” Lancet, Lancet. 2006 Jan 14;367(9505):122-32. 9. Lowy D. R, Solomon D, Hildesheim A, Schiller J. T, and Schiffman M. “Human papillomavirus infection and the primary and secondary prevention of cervical cancer,” Cancer, 2008 Oct 1;113(7 Suppl):1980-93. doi: 10.1002/cncr.23704. 10. Spitzer M, Apgar B. S, Brotzman G. L, and Krumholz B, “Residency training in colposcopy: a survey of program directors in obstetrics and gynecology and family practice.,” Am. J. Obstet. Gynecol., 2001. 2001 Aug;185(2):507-13. 11. Özsoy AZ, Çetin M, Çetin A. “Vajinal Smear İncelemesinde Skuamöz İntraepitelyal Lezyon Saptanan Olguların Kolposkopik Klinik ve Histopatolojik Bulgularının İlişkisinin İncelenmesi,” Gaziosmanpaşa Üniversitesi Tıp Fak. Derg., no. 3, pp. 208–217, 2015. 12. Mitchell M. F, Schottenfeld D, Tortolero-Luna G, Cantor S. B, and Richards-Kortum R. “Colposcopy for the diagnosis of squamous intraepithelial lesions: A meta-analysis,” Obstet. Gynecol., Apr;91(4):626-31. 13. Mousavi A. S, Fakour F, Gilani M. M, Behtash N, Ghaemmaghami F, and Zarchi M. K. “A prospective study to evaluate the correlation between reid colposcopic index impression and biopsy histology,” J. Low. Genit. Tract Dis., 2007. Jul;11(3):147-50. 14. Cantor SB1, Cárdenas-Turanzas M, Cox DD, Atkinson EN, Nogueras-Gonzalez GM, Beck JR. Et al.“Accurary of colposcopy in the diagnostic setting compared with the screening setting,” Obs. Gynecol, 2008 Jan;111(1):7-14. doi: 10.1097/01.AOG.0000295870.67752.b4. 15. Jovanović AM1, Dikic SD, Jovanovic V, Zamurovic M, Nikolic B, Krsic V et el. “Correlation of human papilloma virus infection with cytology, colposcopy and histopathological examination of the bioptic tissue in low- and high-grade intraepithelial lesions,” Eur J Gynaecol Oncol., 2012;33(5):512-6. 16. Nash JD, Burke TW, Hoskins WJ. “Biologic course of cervical human papillomavirus infection,” Obs. Gynecol, 1987 Feb;69(2):160-2. 17. Arbyn M, Dillner J, Van Ranst M, Buntinx F, Martin-Hirsch P, Paraskevaidis E. “Re: Have we resolved how to triage equivocal cervical cytology (multiple letters) [1],” Journal of the National Cancer Institute. 2004. Sep 15;96(18):1401-2; author reply 1402. 18. Scheungraber C1, Glutig K, Fechtel B, Kuehne-Heid R, Duerst M, Schneider A. “Inner border-A specific and significant colposcopic sign for moderate or severe dysplasia (Cervical Intraepithelial Neoplasia 2 or 3),” J. Low. Genit. Tract Dis., 2009. Jan;13(1):1-4. doi: 10.1097/LGT.0b013e31817ff92a. KARİMOVA ve ark. Reid İndeksi ve Histopatoloji Bozok Tıp Derg 2019;9(4):141-150 Bozok Med J 2019;9(4):141-150
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Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Case Report
Authors

Roya Karimova This is me

Emine Karabük This is me

Güler Ateşer This is me

Pınar Kadiroğulları

Publication Date December 27, 2019
Published in Issue Year 2019 Volume: 9 Issue: 4

Cite

APA Karimova, R., Karabük, E., Ateşer, G., Kadiroğulları, P. (2019). HUMAN PAPİLLOMA VİRUS TARAMA TESTİ POZİTİF SERVİKAL SİTOLOJİK TARAMASI NEGATİF VEYA ÖNEMİ BELİRLENEMEYEN ATİPİK SQUAMOZ HÜCRE SAPTANAN HASTALARIN REİD İNDEKSİ KULLANILARAK SINIFLANDIRILMIŞ KOLPOSKOPİK BULGULARININ HİSTOPATOLOJİK SONUÇLARLA KARŞILAŞTIRILMASI Comparison of Colposcopic Findings Using Reid Index of Patients with Cervical Cytological Screening Negative Atypical Squamous Cell Undetermined Significance, Positive Human Papilloma Virus Screening Test with and Histopathological Results. Bozok Tıp Dergisi, 9(4), 141-150.
AMA Karimova R, Karabük E, Ateşer G, Kadiroğulları P. HUMAN PAPİLLOMA VİRUS TARAMA TESTİ POZİTİF SERVİKAL SİTOLOJİK TARAMASI NEGATİF VEYA ÖNEMİ BELİRLENEMEYEN ATİPİK SQUAMOZ HÜCRE SAPTANAN HASTALARIN REİD İNDEKSİ KULLANILARAK SINIFLANDIRILMIŞ KOLPOSKOPİK BULGULARININ HİSTOPATOLOJİK SONUÇLARLA KARŞILAŞTIRILMASI Comparison of Colposcopic Findings Using Reid Index of Patients with Cervical Cytological Screening Negative Atypical Squamous Cell Undetermined Significance, Positive Human Papilloma Virus Screening Test with and Histopathological Results. Bozok Tıp Dergisi. December 2019;9(4):141-150.
Chicago Karimova, Roya, Emine Karabük, Güler Ateşer, and Pınar Kadiroğulları. “HUMAN PAPİLLOMA VİRUS TARAMA TESTİ POZİTİF SERVİKAL SİTOLOJİK TARAMASI NEGATİF VEYA ÖNEMİ BELİRLENEMEYEN ATİPİK SQUAMOZ HÜCRE SAPTANAN HASTALARIN REİD İNDEKSİ KULLANILARAK SINIFLANDIRILMIŞ KOLPOSKOPİK BULGULARININ HİSTOPATOLOJİK SONUÇLARLA KARŞILAŞTIRILMASI Comparison of Colposcopic Findings Using Reid Index of Patients With Cervical Cytological Screening Negative Atypical Squamous Cell Undetermined Significance, Positive Human Papilloma Virus Screening Test With and Histopathological Results”. Bozok Tıp Dergisi 9, no. 4 (December 2019): 141-50.
EndNote Karimova R, Karabük E, Ateşer G, Kadiroğulları P (December 1, 2019) HUMAN PAPİLLOMA VİRUS TARAMA TESTİ POZİTİF SERVİKAL SİTOLOJİK TARAMASI NEGATİF VEYA ÖNEMİ BELİRLENEMEYEN ATİPİK SQUAMOZ HÜCRE SAPTANAN HASTALARIN REİD İNDEKSİ KULLANILARAK SINIFLANDIRILMIŞ KOLPOSKOPİK BULGULARININ HİSTOPATOLOJİK SONUÇLARLA KARŞILAŞTIRILMASI Comparison of Colposcopic Findings Using Reid Index of Patients with Cervical Cytological Screening Negative Atypical Squamous Cell Undetermined Significance, Positive Human Papilloma Virus Screening Test with and Histopathological Results. Bozok Tıp Dergisi 9 4 141–150.
IEEE R. Karimova, E. Karabük, G. Ateşer, and P. Kadiroğulları, “HUMAN PAPİLLOMA VİRUS TARAMA TESTİ POZİTİF SERVİKAL SİTOLOJİK TARAMASI NEGATİF VEYA ÖNEMİ BELİRLENEMEYEN ATİPİK SQUAMOZ HÜCRE SAPTANAN HASTALARIN REİD İNDEKSİ KULLANILARAK SINIFLANDIRILMIŞ KOLPOSKOPİK BULGULARININ HİSTOPATOLOJİK SONUÇLARLA KARŞILAŞTIRILMASI Comparison of Colposcopic Findings Using Reid Index of Patients with Cervical Cytological Screening Negative Atypical Squamous Cell Undetermined Significance, Positive Human Papilloma Virus Screening Test with and Histopathological Results”, Bozok Tıp Dergisi, vol. 9, no. 4, pp. 141–150, 2019.
ISNAD Karimova, Roya et al. “HUMAN PAPİLLOMA VİRUS TARAMA TESTİ POZİTİF SERVİKAL SİTOLOJİK TARAMASI NEGATİF VEYA ÖNEMİ BELİRLENEMEYEN ATİPİK SQUAMOZ HÜCRE SAPTANAN HASTALARIN REİD İNDEKSİ KULLANILARAK SINIFLANDIRILMIŞ KOLPOSKOPİK BULGULARININ HİSTOPATOLOJİK SONUÇLARLA KARŞILAŞTIRILMASI Comparison of Colposcopic Findings Using Reid Index of Patients With Cervical Cytological Screening Negative Atypical Squamous Cell Undetermined Significance, Positive Human Papilloma Virus Screening Test With and Histopathological Results”. Bozok Tıp Dergisi 9/4 (December 2019), 141-150.
JAMA Karimova R, Karabük E, Ateşer G, Kadiroğulları P. HUMAN PAPİLLOMA VİRUS TARAMA TESTİ POZİTİF SERVİKAL SİTOLOJİK TARAMASI NEGATİF VEYA ÖNEMİ BELİRLENEMEYEN ATİPİK SQUAMOZ HÜCRE SAPTANAN HASTALARIN REİD İNDEKSİ KULLANILARAK SINIFLANDIRILMIŞ KOLPOSKOPİK BULGULARININ HİSTOPATOLOJİK SONUÇLARLA KARŞILAŞTIRILMASI Comparison of Colposcopic Findings Using Reid Index of Patients with Cervical Cytological Screening Negative Atypical Squamous Cell Undetermined Significance, Positive Human Papilloma Virus Screening Test with and Histopathological Results. Bozok Tıp Dergisi. 2019;9:141–150.
MLA Karimova, Roya et al. “HUMAN PAPİLLOMA VİRUS TARAMA TESTİ POZİTİF SERVİKAL SİTOLOJİK TARAMASI NEGATİF VEYA ÖNEMİ BELİRLENEMEYEN ATİPİK SQUAMOZ HÜCRE SAPTANAN HASTALARIN REİD İNDEKSİ KULLANILARAK SINIFLANDIRILMIŞ KOLPOSKOPİK BULGULARININ HİSTOPATOLOJİK SONUÇLARLA KARŞILAŞTIRILMASI Comparison of Colposcopic Findings Using Reid Index of Patients With Cervical Cytological Screening Negative Atypical Squamous Cell Undetermined Significance, Positive Human Papilloma Virus Screening Test With and Histopathological Results”. Bozok Tıp Dergisi, vol. 9, no. 4, 2019, pp. 141-50.
Vancouver Karimova R, Karabük E, Ateşer G, Kadiroğulları P. HUMAN PAPİLLOMA VİRUS TARAMA TESTİ POZİTİF SERVİKAL SİTOLOJİK TARAMASI NEGATİF VEYA ÖNEMİ BELİRLENEMEYEN ATİPİK SQUAMOZ HÜCRE SAPTANAN HASTALARIN REİD İNDEKSİ KULLANILARAK SINIFLANDIRILMIŞ KOLPOSKOPİK BULGULARININ HİSTOPATOLOJİK SONUÇLARLA KARŞILAŞTIRILMASI Comparison of Colposcopic Findings Using Reid Index of Patients with Cervical Cytological Screening Negative Atypical Squamous Cell Undetermined Significance, Positive Human Papilloma Virus Screening Test with and Histopathological Results. Bozok Tıp Dergisi. 2019;9(4):141-50.
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