Servikal Kanser Taramasında Asetikasit Sonrası İnspeksiyon ile Servikal Smearin Karşılaştırılması

Year 2016, Volume: 13 Issue: 1, 1 - 8, 28.04.2016

Hacer Uyanıkoğlu , Ceyhun Numanoğlu Ahmet Gülkılık

Abstract

Amaç: Bu çalışmada servikal kanser taramasında asetik asit uygulaması sonrası vizüel inspeksiyon (VIA)
yöntemi ile geleneksel pap smearin karşılaştırılması amaçlanmıştır.
Materyal Metod: Hastanemize başvuran 30-55 yaş arası, histerektomi ve konizasyon geçirmemiş, vajinal
kanaması olmayan 95 hastadan önce servikal smear alındı, daha sonra %3'lük asetik asit uygulanarak vizüel
inspeksiyonla asetowhite alan tarandı. Son olarak hastalardan, şüpheli alanlardan ve şüpheli alan yoksa 4
kadrandan (saat 12, 15, 18, 21 ) randomize biopsi alındı. Test doğruluğunu saptamada altın standart olarak
biopsi kullanıldı.
Bulgular: Taranan 95 hastanın yaş ortalaması 41.06 (yaş dağılımı 30-55), Ortalama evlilik yılı 20.28 (1-42)
idi. Ortalama gebelik sayısı 4.03; parite sayısı 2.50 idi. 33 hasta (%34.73) sigara içiyor; 38 hasta (%40)
hayatlarının herhangi bir döneminde oral kontraseptif kullanmış idi. Toplam 95 hastanın 51 tanesi (%53.6)
VIApozitif, 38 tanesi (%40) smear pozitif, 31 (%32.6) tanesi biopsi pozitif idi. VIA'nın sensitivitesi %56.8,
spesifitesi %95.4, pozitif prediktif değeri % 93.5, negatif prediktif değeri % 65.6 idi. Smearin sensitivitesi
%47.3, spesifitesi %77.1, pozitif prediktif değeri % 58, negatif prediktif değeri %68.7 idi.
Sonuç: Asetik asit sonrası vizüel inspeksiyonla tarama yönteminin (VIA), sensitivitesi ve negatif prediktif
değeri smeare yakın (%56.8'e 47.3; %65.6'a 68.7), spesifitesi ve pozitif prediktif değeri anlamlı olarak
yüksek (%95.4'e 77.1; %93.5'a 58) bulundu. Daha ekonomik olması da göz önüne alınarak, VIA servikal
kanser taramasında smeare alternatif bir metod olarak kullanılabilir. 

Keywords

Vajinal Smear, Asetik Asit, Servikal Kanser

Comparison of Visual Inspection of Cervix with Acetic Acid and Smear for Cervical Cancer Screening

Abstract

Background: In this study we purposed to compare visual inspection of acetic acid (VIA) with cytology as a
traditional screening program.
Material and methods: Ninety five women entered to the study. They were aged 30-55. The patients has no
history of hysterectomy and conisation. During speculum examination, firstly cervical smear was taken and
then acetic acid (3%) was applied over the cervix. Then acetowhite area was screened with simple visual
inspection. Lastly, four quadrant (12, 15, 18, 21 o'clock) biopsy was taken from all women. Biopsy results
were used as a gold standart to detect correction of tests. Results: The mean age of the women was 41.06 (range 30-55), and the mean period of marriage was 20.28 (1-
42) years. Average gravity was 4.03 and parity was 2.50. 33 patient were smoking (34.73%), 38 patient (40%)
had been used oral contraceptive drugs at the any part of their life. Of the 95 women examined using the VIA,
51(53.6%) were positive, and the smear was abnormal in 38 (40%) patients. And biopsi was positive in 31
(32.6%). The sensitivity of VIAwas 56.8%, the specificity was 95.4%, positive predictive value was 93.5%,
negative predictive value was 65.6%. The sensitivity of smear was 47.3%, specificity was 77.1%, PPV was
58% and NPVwas 68.7%.
Conclucion: The sensitivity and negative predictive value of VIA was found near to smear (56.8 %, 65.6 vs
47.3, 68.7), the specificity and positive predictive value of VIAhigher than smear (95.4 %, 93.5 vs 77.1, 58).
We thought that VIAcan usable an alternative method to smear for cervical cancer screening in low resource
settings.

Keywords

Vaginal Smear, Acetic Acid, Cervical Cancer

References

• 1)Zekioglu O, Ozdemir N. Serviks Kanserleri Patolojisi [Cervical Carcinoma]. Turkiye Klinikleri J Med OncolSpecial Topics 2011;4(1):14-9.
• 2)Ortac F, Taskın S. Serviksin Malign Hastalıkları [Malıgn Disorders of Cervix]. Turkiye Klinikleri J Surg Med Sci 2007;3(40):55-8.
• 3) Sankaranarayanan R, Ramani S, Wesley R. Servikal Neoplazilerde Gözle Tarama Pratik El Kitabı [Practical Handbook of Cervical Neoplasia Eye Scan]. 2005:15- 24.
• 4) Saygılı U, Saatli B. Uterus Korpus ve Serviksinin Premalign Lezyonları [Premalign Lesion Of Uterin Corpus And Cervix]. Turkiye Klinikleri J Surg Med Sci 2007;3(40):36-44.
• 5) Hasanzadeh M, Esmaeili H, Tabaee S, Samadi F. Evaluation of visual inspection with acetic acid as a feasible screening test for cervical neoplasia. 2011;37(12):1802-6.
• 6) Phongsavan K, Phengsavanh A, Wahlstram R, Marions L. Safety, feasibility, and acceptability of visual inspection with acetic acid and immediate treatment with cryotherapy in rural Laos. 2011;114(3):268-72.
• 7) Ibrahim A, Rasch V, Pukkala E, Aro AR. Cervical cancer risk factors and feasibility of visual inspection with acetic acid screening in Sudan. 2011;4(3):117-22.
• 8) Qiao YL. Perspective of cervical cancer prevention and control in developing countries and areas. 2010;29(1):1- 3.
• 9) Ozan H. Servikal Karsinogeneziste HPV'nin Rolü [The Role of HPV in Cervical Carcinogenesis]. Turkiye Klinikleri J Gynecol Obst-Special Topics 2009;2(1):9-12.
• 10) Yazıcı F, Tazegul A, Esen H, Celik C. Anormal Servikovajinal Smear Saptanan Hastalarda Kolposkopi Eşliğinde Alınan Biyopsi Sonuçlarının Değerlendirilmesi [The The Evaluation of the Biopsy Results Taken Under Colposcopy in Patients with Abnormal Cervicovaginal Smear Results]. Turkiye Klinikleri J Gynecol Obst 2011;21(2):83-8.
• 11) Fahey MT, Irwig L, Macaskill P. Meta-analysis of Pap test accuracy. Am J Epidemiol 1995;141(7):680-9.
• 12) Coppleson M. Control of carcinoma of cervix by exfoliative cytology screening. Gynecol Oncol 1992;34(1):543.
• 13) Bellison JL, Pretorius RG, Zhang WH, Wu LY, Qiao YL. Cervical cancer screening by simple visual inspection after acetic acid. Obstet Gynecol 2001;98(3):441-4.
• 14) Sankaranarayanan R, Wesley R, Somanathan T, Dhakad N, Shyamalakumary B, Amma NS, et al. Visual inspection of the uterine cervix after the application of acetic acid in the detection of cervical carcinoma and its precursors. Cancer 1998 1998;83(10):2150-6.
• 15) Ghaemmaghami F, Behtash N, Modares Gilani M, Mousavi A, Marjani M, Moghimi R. Visual inspection with acetic acid as a feasible screening test for cervical neoplasia in Iran. Int J Gynecol Cancer 2004;14(3):465-9.
• 16) Qureshi S, Das V, Zahra F. Evaluation of visual inspection with acetic acid and Lugol's iodine as cervical cancer screening tools in a low-resource setting. Trop Doct 2010;40(1):9-12.
• 17) Hegde D, Shetty H, Shetty PK, Rai S. Diagnostic value of acetic acid comparing with conventional Pap smear in the detection of colposcopic biopsy-proved CIN. J Cancer Res Ther 2011;7(4):454-8.
• 18) Khodakarami N, Farzaneh F, Aslani F, Alizadeh K. Comparison of Pap smear, visual inspection with acetic acid, and digital cervicography as cervical screening strategies. Arch Gynecol Obstet 2011;284(5):1247-52.
• 19) Consul S, Agrawal A, Sharma H, Bansal A, Gutch M, Jain N. Comparative study of effectiveness of Pap smear versus visual inspection with acetic acid and visual inspection with Lugol's iodine for mass screening of premalignant and malignant lesion of cervix. Indian J Med Paediatr Oncol 2012;33(3):161-5.
• 20) Cronje HS. Screening for cervical cancer in a developing countries. Int J Gynecol and Obstet 2004;84(2):101-8.