Evaluation and management of patients referred to our center with suspicion of cervical pathology

Year 2021, Volume: 3 Issue: 1, 1 - 6, 28.03.2021

Recep Erin Kübra Baki Erin Deniz Kulaksız Yeşim Bayoğlu Tekin Hatice Küçük

https://doi.org/10.46969/ezh.806585

Abstract

Aim: To determine the prevalence of Human Papilloma Virus (HPV) positivity in our region and to examine the type distribution and management of HPV positive cases.
Materials and Methods: Patients who applied to the University of Health Sciences, Trabzon Kanuni Health Practice and Research Center between January 2018 and December 2019 for further examination and examination with suspicion of cervical pathology were retrospectively analyzed. Demographic data of the patients were determined. HPV typing and smear results detected in the patients were recorded. Biopsy and colposcopy results of patients with high-risk HPV types were evaluated. Study data were analyzed using descriptive statistical methods.
Results: 6,186 patients who were tested for HPV were included in the study. The mean age, body mass index and gravida of the patients were 43.87 ± 7.1 years, 27.1 ± 6.56 kg / m2, and 3.4 ± 0.43, respectively. Smoking rate was 22.8% and HPV positivity was 5.45% (n = 337/6186). Distribution of patients' cervical smear results were determined as normal 54.3% (n = 183), infection 19.29% (n = 65), ASC-US 5.64% (n = 19), L-SIL 2.37% (n = 8) and AGC% 0.30 (n = 1). The most common types in HPV typing were HPV 16 in 91 patients (27%), HPV 31 in 45 patients (13.4%), HPV 51 in 43 patients (12.8%), HPV 52 in 43 patients (12.8%) In colposcopic biopsy results, 49.6% (n = 167) cervical intraepithelial neoplasia (CIN) 1, 7.4% (n = 25) CIN 2-3, 1.2% (n = 4) squamous cell carcinoma cases were detected.
Conclusion: Within the results of our study, the importance of cervical cancer screening in sexually active women has been demonstrated once again. The importance of participating in cervical cancer screening programs performed with the combination of HPV DNA and cervical smear should be kept in mind. To our knowledge, our study is the first to show the HPV prevalence of the Eastern Black Sea Region in cross-section.

Keywords

Eastern Black Sea, Human Papilloma Virus, cervical smear, cervical intraepithelial lesion, colposcopy, cervical cancer, Eastern Black Sea

Servikal patoloji şüphesi ile merkezimize refere edilen hastaların değerlendirilmesi ve yönetimi

Abstract

Amaç: Bölgemizdeki İnsan Papilloma Virüs (HPV) pozitiflik prevalansını belirlemek ve HPV pozitif olguların tip dağılımını ve yönetimini incelemektir.
Gereç ve Yöntem: Servikal patoloji şüphesi ile ileri tetkik ve inceleme için Ocak 2018 – Aralık 2019 tarihleri arasında Sağlık Bilimleri Üniversitesi Trabzon Kanuni Sağlık Uygulama ve Araştırma Merkezi’ne başvuran hastalar retrospektif olarak incelendi. Hastaların demografik verileri belirlendi. Hastalarda saptanan HPV tiplendirilmesi ve smear sonuçları kaydedildi. Yüksek riskli HPV tipi gözlenen ve kolposkopi yapılan hastaların biyopsi sonuçları değerlendirildi. Çalışma verileri tanımlayıcı istatistiki metodlar kullanılarak analiz edildi.
Bulgular: Çalışmaya HPV testi yapılan 6186 hasta dahil edildi. Hastaların yaş ortalaması 43,87 ± 7,1 yıl, vücut kitle indeksi 27,1 ± 6,56 kg/m2, gravidası 3,4 ± 0,43 idi. Sigara kullanım oranı %22,8, HPV pozitifliği %5,45 (n=337/6186) olarak saptandı. Hastaların servikal smear sonuçlarının dağılımı; normal %54,3 (n=183), enfeksiyon %19,29 (n=65), ASC-US %5,64 (n=19), L-SIL %2,37 (n=8), AGC %0,30 (n=1) olarak tespit edildi. HPV tiplendirmesinde en sık görülen tipler 91 hastada HPV 16 (%27), 45 hastada HPV 31 (%13,4), 43 hastada HPV 51 (%12,8), 43 hastada HPV 52 (%12,8) şeklinde idi. Kolposkopik biyopsi sonuçlarında %49,6 (n=167) servikal intraepitelyal neoplazi (CIN) 1, %7,4 (n=25) CIN 2-3, %1,2 (n=4) skuamöz hücreli karsinom tespit edildi.
Sonuç: Çalışmamız sonuçları dahilinde cinsel aktif kadınlarda servikal kanser taramasının önemi bir kere daha ortaya konmuştur. 30 yaş üzerinde HPV DNA ve servikal smear kombinasyonu ile yapılan serviks kanseri tarama programlarına katılmanın önemi akılda tutulmalıdır. Çalışmamız Doğu Karadeniz Bölgesi’nin HPV prevalansını kesitsel olarak göstermesi açısından bir ilktir. 

Keywords

Human papilloma virüs, servikal smear, servikal intraepitelyal lezyon, kolposkopi, serviks kanseri, Doğu Karadeniz

References

• Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, Ocfemia MC, Su J, Xu F, Weinstock H. 2013. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008 Sex Transm Dis 2013; 40:187-193.
• Dunne EF, Park IU. HPV and HPV-associated diseases. Infect Dis Clin North Am 2013; 27:765-778.
• Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68:394-424.
• Gong P, Wang Z, Geng J, Tan X. Comparative Study on Detection and Typing of Human Papillomavirus (HPV) Infection with Microarray Using Paraffin-Embedded Specimens from Squamous Cell Carcinoma and Cervical Precursor Lesions. J Nanosci Nanotechnol 2017; 17:990-997.
• Kaleli İ, Aksoy L, Demir M, et al. Prevalence and Genotype Distribution of Human Papillomavirus in Patients Attending to Gynecology Polyclinics Mikrobiyol Bul 2019; 53:170-178.
• Hasbek M, Çelik C, Çabuk A, Bakıcı MZ. Sivas Bölgesinde Servikal Örneklerde Human papillomavirus Sıklığı ve Genotip Dağılımı. Türk Mikrobiyol Cem Derg 2018; 48:199-204.
• Schiffman M, Herrero R, Desalle R, et al. The carcinogenicity of human papillomavirus types reflects viral evolution. Virology 2005; 337:76-84.
• Baseman JG, Koutsky LA. The epidemiology of human papillomavirus infections. J Clin Virol 2005; 32:16-24.
• Dehn D, Torkko KC, Shroyer KR. Human papillomavirus testing and molecular markers of cervical dysplasia and carcinoma. Cancer 2007; 111:1-12.
• Mavi Aydoğdu SG, Özsoy Ü. Cervical cancer and HPV. Androl Bul 2018; 20:25−29.
• Yıldırım D. Gökaslan H. Serviks kanseri taramasında HPV DNA testinin yeri. Türk Jinekolojik Onkoloji Dergisi 2015; 1:1–6.
• 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. Am J Clin Pathol 2012; 137:516-542.
• Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin Number 131: Screening for cervical cancer. Obstet Gynecol 2012; 120:1222–1238.
• Sağlık Bakanlığı, Halk Sağlığı Genel Müdürlüğü (2020), HPV Tarama Testi https://hpvtarama.saglik.gov.tr/duyurular/Sayfa/ HpvTaramaTestiNasilYapilir [Erişim tarihi: 24.09.2020].
• Bruni L, Diaz M, Castellsagué X, Ferrer E, Bosch FX, de Sanjosé S. Cervical human papillomavirus prevalence in 5 continents: metaanalysis of 1 million women with normal cytological findings. J Infect Dis 2010; 202:1789-1799.
• Aslan FG, Us T, Kaşifoğlu N, et al. The positivity for human papillomavirus (hpv) dna and evaluation of probable risk factors among women in Eskişehir region. Taf Prev Med Bull 2015;14:222–228.
• Kan Ö, Görkem Ü, Barış A, Koçak Ö, Toğrul C, Yıldırım E. Evaluation of the frequency of human papillomavirus (HPV) in women admitted to cancer early diagnosis and screening training centers (KETEM) and analysis of HPV genotypes. Turk Hij Den Biyol Derg 2019; 76:163–168.
• Sahin HG, Kolusari A, Guducuoglu H. Prevalence of high risk human papillomavirus (HPV) infection and abnormal cervical cytology and knowledge about HPV vaccine in Eastern Turkey. Eur J Gynaecol Oncol 2017; 38:241-244.
• Findik S, Findik S, Abuoğlu S, Cihan FG, Ilter H, Iyisoy MS. Human papillomavirus (HPV) subtypes and their relationships with cervical smear results in cervical cancer screening: a communitybased study from the central Anatolia region of Turkey. Int J Clin Exp Pathol 2019; 12:1391-1398.
• Dursun P, Ayhan A, Mutlu L, et al. HPV Types in Turkey: Multicenter Hospital Based Evaluation of 6388 Patients in Turkish Gynecologic Oncology Group Centers. Turk Patoloji Derg 2013; 29:210-216.
• Demirel EE, Şahin HÖ, Preinvaziv ve invaziv servikal lezyonlarda Human Papillomavirus (HPV) tiplerinin prevalansının saptanması. Balıkesir Med J 2018; 2:185-179.