Analysis of Cold-knife Conization Results in HPV Positive Patients

Öz

Aim:

To perform the retrospective analysis of cases with cold-knife conization operation. We aimed to determine the risk of positive surgical margins in HPV 16/18 positivite and postmenapausal women.

Materials and Methods:

After approval of the Ethical Commitee, the medical record of patients who had undergone a cold-knife conization surgical procedure in our clinic between January 2015 and July 2017 were reviewed.  We included 51 cold-knife conization case that were referred to us for HPV positivity. We  have investigated parameters such as age, menopausal status, cervical smear, human papilloma virus (HPV), colposcopic biopsy / conization histopathological evaluation and positive surgical margin. HPV analysis results were grouped as follows to investigate the effect of HPV 16 and 18. Group I: positivity of HPV 16 and / or 18, group II: other high risk (HR) HPV positivite (HPV 16/18 negative). Cold-knife conization results were divided in two groups; normal/low dysplasia group (Normal and CIN I), severe dysplasia group (CIN II / III and CIS).

Results:

Cervical smear results were as follows; Normal 27 (52.9%), ASCUS 2 (3.9%), LGSIL 14 (27.5%) and HSIL 8 (15.7%). The results of colposcopy were as follows; CIN I 18 (35.3%), CIN II / III 33 (64.7%). Cold-knife conization histopathological results were as follows; 12 (23.5%) normal, 8 (15.7%) CIN I, 23 (45.1%) CIN II / III, 8 (15.7%) CIS.

28 patients were in group I (HPV 16/18 positive), whereas 23 patients were in group II ( other HR-HPV positive).

Normal/low dysplasia rate was 35.7% (10/28), severe dysplasia rate was 64.3% (18/28), positive surgical margin rate was 21.4% (6/28) in the group I. And normal/low dysplasia rate was 43.5% (10/23), severe dysplasia rate was 56.5% (13/23), positive surgical margin rate was 8.6% (2/23) in the group II.

In generally positive surgical margin rate after cold-knife conization operation was 15.7% (8/51). In postmenopausal patients, more positivite surgical magrin was detected (21.1% - 12.5%).

Conclusion:

We know that HPV 16 and 18 are more effective than other HR HPVs in the etiopathogenesis of cervical cancer. But there was no significant difference between the groups in terms of severe dysplasia and positive surgical margin. We think that more extensive studies will give clearer results. We also think more emphasis should be given to HR HPVs in routine screening, colposcopy follow-up and vaccination program in this data light.

Anahtar Kelimeler

• Cold-knife Conization,Human papilloma virus,Menapause

HPV Pozitif Hastalarda Soğuk Konizasyon Sonuçlarının Analizi

Öz

Amaç:

Çalışmamızda soğuk konizasyon operasyonu olan hastaların retrospektif analizini yapmak. Amacımız konizasyon sonrası cerrahi alan pozitifliği olan hastalarda HPV 16/18 pozitifliği ve menapozal durumun etkisini ortaya koymayı amaçladık.

Gereç ve Yöntem:

Etik kurul onayı sonrası Ocak 2015 ile Temmuz 2017 arasında kliniğimizde soğuk konizasyon ameliyatı olan hastaların medikal kayıtları incelendi. HPV pozitifliği nedeniyle yaönlendirilen 51 soğuk konizasyon vakası çalışmaya dahil edildi. Yaş, menapozal durum, servikal smear, Human papillomavirüs (HPV), kolposkopik biyopsi / konizasyon histopatolojik değerlendirmesi ve cerrahi sınır pozitifliği değerlendirildi. HPV 16 ve 18’in etkisini değerlendirmek için hastalar iki gruba ayrıldı; Grup I: HPV 16 ve/veya 18 pozitifliği, grup II: diğer yüksek riskli (HR) HPV pozitifliği (HPV 16/18 negatif). Soğuk konizasyon sonuçları da iki gruba ayrıldı; normal/düşük displazi grup (Normal and CIN I), ağır displazi grup (CIN II / III and CIS).

Bulgular:

Servikal smear sonuçları şu şekilde idi; Normal 27 (52.9%), ASCUS 2 (3.9%), LGSIL 14 (27.5%) and HSIL 8 (15.7%). Kolposkopi sonuçları ise şöyle idi; CIN I 18 (35.3%), CIN II / III 33 (64.7%). Soğuk konizasyon sonuçları ise şu şekilde idi; 12 (23.5%) normal, 8 (15.7%) CIN I, 23 (45.1%) CIN II / III, 8 (15.7%) CIS.

28 hasta grup I (HPV 16/18 pozitif) iken 23 hasta grup II (diğer yüksek riskli HPV pozitif) olarak bulundu.

Grup I’de normal/düşük displazi oranı 35.7% (10/28), ağır displazi oranı 64.3% (18/28), cerrahi sınır pozitifliği oranı 21.4% (6/28) idi.  in the group I. Grup II’de ise normal/düşük displazi oranı 43.5% (10/23), ağır displazi oranı 56.5% (13/23), cerrahi sınır pozitifliği oranı 8.6% (2/23) idi.

Sonuç olarak konizasyon sonrası cerrahi sınır pozitifliği 15.7% (8/51) olarak bulundu. Postmenapozal hastalarda ise daha fazla cerrahi sınır pozitifliği saptandı(21.1% - 12.5%).

Sonuç:

Serviks kanseri etyopatogenezinde HPV 16 ve 18’in diğer yüksek riskli HPV’lere oranla daha etkili olduğunu biliyoruz. Ancak çalışmamızda gruplar arasında ağır displazi ve cerrahi sınır pozitifliği açısından anlamlı bir fark saptamadık. Daha ileri çalışmalar ile daha net sonuçlar alınabileceğini düşünmekteyiz. Bu bilgiler ışığında rutin tarama, kolposkopi takibi ve aşılama programlarında diğer yüksek riskli HPV’lere gereken önemin verilmesi gerektiğini düşünüyoruz.   

Anahtar Kelimeler

• Soğuk konizasyon,Human papillomavirüs,Menapoz

Kaynakça

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