Human Papillomavirüs (HPV), Servikal Smear ve Kolposkopik Biyopsi Sonuçlarının Karşılaştırılması: Serviks Kanseri Taramasında Bir Üniversite Hastanesinin 4 Yıllık Deneyimi

Abstract

Amaç: Sitolojinin sensitivitesi görece düşük olduğu için serviks kanseri taramasında Human papillomavirus (HPV) DNA ile tarama önerilmektedir. Bu çalışmanın amacı HPV, servikal smear ve kolposkopik biyopsi sonuçları arasındaki uyumu araştırmaktır. Gereçler ve Yöntem: Ordu Üniversitesi Eğitim ve Araştırma Hastanesi’nde Ocak 2018-Aralık 2021 yılları arasında kolposkopik biyopsi alınan hastalar geriye dönük taranmıştır. Herhangi bir yüksek riskli HPV pozitifliği olan, servikal smear ve kolposkopik biyopsi sonucu bulunan hastalar çalışmaya dahil edilmiştir. HPV tipleri, smear ve biyopsi sonuçları karşılaştırılmıştır. Bulgular: Çalışmaya 734 hasta dahil edilmiştir. Hastaların ortalama yaşı 41.9 ± 7.36’dır. 165 (%22.5) hastada tek başına HPV 16, 35 (%4.8) hastada tek başına HPV 18, 354 (%48.2) hastada diğer yüksek riskli HPV tiplerinden biri ve 180 (%24.5) hastada en az iki HPV tipi birlikte tespit edilmiştir. 298 (%40.6) hastada HPV 16 ve/veya HPV 18 tek başına ya da başka tiplerle bir arada bulunmaktadır. Hastaların çoğunda (%55.3) smear sonucu normal iken ASC-US en sık saptanan sitolojik anormallik olmuştur. Kolposkopi eşliğinde alınan biyopsi sonuçları şu şekildedir: 452 (%61.6) normal, 199 (%27.1) CIN 1, 36 (%4.9) CIN 2, 42 (%5.7) CIN 3 ve 5 (%0.7) skuamoz hücreli karsinom. HPV 16 ve/veya HPV 18 olan hastaların %66.1’inde smear sonucu normal olmasına karşın diğer yüksek-riskli HPV subtiplerine göre daha fazla ≥CIN 2 lezyon saptanmıştır (%19.8 vs %5.5, p<0.001). Bir veya daha fazla HPV subtipi ile enfekte olmakla lezyon şiddeti arasında istatistiksel olarak anlamlı bir fark yoktur (p=0.474). Smear testinin sensitivitesi %55.2, spesifisitesi %69.2 olarak bulunmuştur. Sonuç: HPV 16 ve/veya HPV 18 ile enfekte olan hastaların smear sonuçları çoğunlukla normal olsa da bu hastaların yaklaşık %20’sınde ≥CIN 2 lezyon bulunmaktadır. Smear testinin sensitivitesi düşük olduğundan HPV genotiplendirme ile tarama daha güvenilir bir yöntemdir.

Keywords

• Human papillomavirus DNA testi
• servikal smear
• kolposkopi
• serviks kanseri taraması

Relationship Between Human Papillomavirus (HPV), Cervical Smear Cytology and Colposcopy Directed Biopsy Results: 4 Year Experience of a University Hospital in Cervical Cancer Screening

Abstract

Aim: Cervical cancer screening guidelines gradually recommend human papillomavirus (HPV) DNA testing since sensitivity of cytology is relatively low. This study aimed to evaluate correlation between HPV, cervical smear cytology and colposcopy directed biopsy results. Material and Methods: Patients who underwent colposcopy directed biopsy in Ordu University Training and Teaching Hospital between January 2018 and December 2021 were retrospectively reviewed. Patients with any high-risk HPV positivity who had cervical smear cytology and colposcopy directed biopsy results were included to this study. Results of HPV subtypes, cervical smear and histologic biopsy were recorded. Results: A total of 734 patients were included to this study. The mean age of the patients was 41.9 ± 7.36 years. Hundred and sixty-five (22.5%) patients had HPV 16 alone, 35 (4.8%) had HPV 18 alone, 354 (48.2%) had other high-risk HPV subtypes alone and 180 (24.5%) had more than one high-risk HPV subtypes. Two hundred and ninety-eight (40.6%) had HPV 16 or HPV 18 either alone or in combination with other subtypes. Majority of the patients (55.3%) had normal cervical smear results followed by ASC-US (27%). Colposcopy directed biopsy results were as follows: 452 (61.6%) normal, 199 (27.1%) CIN 1, 36 (4.9%) CIN 2, 42 (5.7%) CIN 3 and 5 (0.7%) squamous cell cancer. 66.1% of the patients with HPV 16 and/or HPV 18 had normal cervical cytology results, but they had significantly more ≥CIN 2 lesions compared to other high-risk HPV subtypes (19.8% vs 5.5%, p<0.001). There wasn’t a statistical difference between having one or more than one HPV subtype in terms of severity of the lesions (p=0.474). The sensitivity and specificity of cervical smear cytology test were 55.2% and 69.2%, respectively. Conclusion: Although patients with HPV 16 and/or HPV 18 were more likely to have normal cervical cytology results, almost 20% of them had CIN 2 + lesions. Sensitivity of cervical cytology remains low and HPV DNA test with genotyping is more reliable as a screening tool.

Keywords

• Human Papillomavirus DNA test
• cervical smear
• colposcopy
• cervical cancer screening

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