COLPOSCOPIC EXAMINATION IN CYTOLOGY NEGATIVE WOMEN WHO TESTED POSITIVE FOR NON-16/18 HPV TYPES

Abstract

Objective: To assess the colposcopic examination findings and biopsy results in women who tested positive for oncogenic Human Papilloma Virus (HPV) types other than HPV-16 and 18 while having otherwise normal Pap test results.

Material and Method: This paper analyzes the results from a total of 300 women who tested positive for non-16/18 HPV types but had otherwise normal Pap test and underwent a colposcopic examination in our hospital between January 2017 and December 2017. The study subjects presented with postcoital bleeding, had a family history of cancer or exhibited macroscopic examination findings which were suspected to be malign. A co-test was scheduled one year later for 39 patients (13%) who had no lesions suspected of malignancy and a colposcopy-guided tissue sample was performed on 261 patients.

Results: Histological examination results included inflammation (in 186 patients [62%]), CIN 1 (in 61 patients [20.33%]), CIN 2 (in 9 patients [3%], CIN 3 (in 3 patients [1%]) and cervical cancer (in 2 patients [%0.67]).

Conclusion: One should keep in mind that a diagnosis of CIN 2 or more severe lesions or even cervical cancer can be made using a colposcopy-guided biopsy in women who test positive for non 16/18 HPV types but have otherwise normal Pap smear test.

Keywords

• Human papilloma virus (HPV),diagnosis,screening,colposcopy

HPV TİP 16 VE 18 DIŞINDA POZİTİFLİĞİ OLUP SMEAR SONUCU NORMAL OLAN HASTALARIN KOLPOSKOPİK İNCELENMESİ

Abstract

Amaç: Human Papilloma Virüs (HPV) tip 16 ve 18 dışında pozitifliği olup, smear sonucu normal olan hastaların kolposkopik muayene ve biyopsi sonuçlarını incelemek

Gereç ve Yöntem: Çalışmamızda smear sonucu normal, ancak HPV tip 16-18 dışında pozitifliği olan ve Ocak 2017- Aralık 2017 tarihleri arasında hastanemizde kolposkopi yapılan 300 hasta incelendi. Hastalarımızın genel olarak kolposkopi endikasyonu postkoital kanama, ailede jinekolojik malignite öyküsü ve makroskopik şüpheli lezyon bulunması idi. Kolposkopi sırasında şüpheli lezyonu olmayan 39 hastaya (% 13) bir yıl sonra ko-test için kontrole çağrılırken, 261 hastaya kolposkopi kılavuzlu doku örneklemesi yapıldı.

Bulgular: Histolojik inceleme sonuçları 186 hastada (%62) inflamasyon, 61 hastada (%20,33) CIN 1, 9 hastada (%3) CIN 2, 3 hastada (%1) CIN 3 ve 2 hastada (%0,67) servikal kanser olarak rapor edilmiştir.

Sonuç: HPV tip 16-18 dışında pozitifliği olup smear sonucu normal olan hastalarda CIN 2 ve üstü lezyon, hatta kanser teşhisi konulabileceği unutulmamalıdır.

Keywords

• Human papilloma virus (HPV),Smear tabakası,uterin servikal displazi,serviks kanseri,kolposkopi

References

1. Basu P, Meheus F, Chami Y, Hariprasad R, Zhao F, Sankaranarayanan R. Management algorithms for cervical cancer screening and precancer treatment for resourcelimited settings. Int J Gynaecol Obstet 2017;138(Suppl 1): 26-32.
2. Tracht J, Wrenn A, Eltoum IE. Primary HPV testing verification: A retrospective ad-hoc analysis of screeningalgorithms on women doubly tested for cytology and HPV. Diagn Cytopathol 2017;45(7):580-6.
3. MarianiL , Igidbashian S, Sandri MT, Vici P, Landoni F. The clinical implementation of primary HPV screening. Int J Gynaecol Obstet 2017;136(3):266-71.
4. Tshomo U, Franceschi S, Tshokey T, Tobgay T, Baussano I, Tenet V, et al. Evaluation of cytology versus human papillomavirus-based cervical cancer screening algorithms in Bhutan. Oncotarget 2017;8(42):72438-46.
5. Ronco G, Dillner J, Elfström KM, Tunesi S, Snijders PJ, Arbyn M, et al. International HPV screening working group. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomized controlled trials. Lancet 2014;383(9916):524-32.
6. Naucler P, Ryd W, Törnberg S, Strand A, Wadell G, Elfgren K, et al. Human papillomavirus and Papanicolaou tests to screen for cervical cancer. N Engl J Med 2007;357(16):1589-97.
7. Horn J, Denecke A, Luyten A, Rothe B, Reinecke-Lüthge A, Mikolajczyk R, et al. Reduction of cervical cancer incidence within a primary HPV screening pilot Project (WOLPHSCREEN) in Wolfsburg, Germany. Br J Cancer. 2019 Apr 16.
8. Rijkaart DC, Berkhof J, Rozendaal L, van Kemenade FJ, Bulkmans NW, Heideman DA, et al. Human papillomavirus testing for the detection of high-grade cervical intraepithelial neoplasia and cancer: final results of the POBASCAM randomized controlled trial. Lancet Oncol. 2012;13(1):78-88.

9. Cuzick J, Clavel C, Petry KU, Meijer CJ, Hoyer H, Ratnam S, et al. Overview of the European and North American studies on HPV testing in primary cervical cancer screening. Int J Cancer 2006;119(5):1095-101.
10. Arbyn M, Ronco G, Anttila A, Meijer CJ, Poljak M, Ogilvie G, et al. Evidence regarding human papillomavirus testing in secondary prevention of cervical cancer. Vaccine 2012;30(Suppl 5):F88-99.
11. Ronco G, Giorgi-Rossi P, Carozzi F, Confortini M, Dalla Palma P, Del Mistro A, et al. New Technologies for Cervical Cancer Screening Working Group. Results at recruitment from a randomized controlled trial comparing human papilloma virus testing alone with conventional cytology as the primary cervical cancer screening test. J Natl Cancer Inst 2008;100(7):492-501.
12. Cox JT, Schiffman M, Solomon D; ASCUS-LSIL Triage Study (ALTS) Group. Prospective follow-up suggests similar risk of subsequent cervical intraepithelial neoplasia grade2 or 3 among women with cervical intraepithelial neoplasia grade 1 or negative colposcopy and directed biopsy. Am J Obstet Gynecol 2003;188(6):1406-12.
13. Massad LS, Einstein MH, Huh WK, Katki HA, Kinney WK, Schiffman M, et al. 2012 ASCCP Consensus Guidelines Conference. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol 2013;121(4):829-46. Franco EL, Villa LL, Sobrinho JP, Prado JM, Rousseau MC, Désy M, et al. Epidemiology of acquisition and clearance of cervical human papilloma virus infection in women from a high-risk area for cervical cancer. J Infect Dis 1999;180(5):1415-23.
14. Katki HA, Kinney WK, Fetterman B, Lorey T, Poitras NE, Cheung L, et al. Cervical cancer risk for women undergoing concurrent testing for human papilloma virus and cervical cytology: a population-based study in routine clinical practice. Lancet Oncol 2011;12(7):663-72.
15. Karaca İ, Öztürk M, Comba C, Demirayak G, Alay İ, Erdoğan VŞ, et al. Immediate biopsy of cervical cytology-negative and non-HPV-16/18 oncogenic types positive patients. Diagn Cytopathol 2018;46(4):326-30.
16. Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, 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;(16(3):175-204.
17. Ronco G, Zappa M, Franceschi S, Tunesi S, Caprioglio A, Confortini M, et al. Italian HPV Survey Working Group. Impact of variations in triage cytology interpretation on human papillomavirus-based cervical screening and implications for screening algorithms. Eur J Cancer 2016;68:148-55.
18. Çelik AS, Pasinlioğlu T. Klimakterik dönemdeki kadınların yaşadıkları menopozal semptomlar ve etkileyen faktörler. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi 2014;16-29.
19. Kitchener HC, Almonte M, Thomson C, Wheeler P, Sargent A, Stoykova B, et al. HPV testing in combination with liquidbased cytology in primary cervical screening (ARTISTIC): a randomised controlled trial. Lancet Oncol 2009;10(7):672-82.
20. Naucler P, Ryd W, Törnberg S, Strand A, Wadell G, Elfgren K, et al. Human papillomavirus and Papanicolaou tests to screen for cervical cancer. N Engl J Med 2007;357(16):1589-97.