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Yetersiz servikal sitolojiye sahip yüksek riskli HPV pozitif kadınların kolposkopi bulgularının analizi

Year 2021, Volume: 18 Issue: 1, 702 - 706, 01.04.2021
https://doi.org/10.38136/jgon.846750

Abstract

Amaç: Çalışmanın amacı Kanser Erken Tanı ve Tarama Merkezlerinden Jinekolojik Onkoloji polikliniğine sevk edilen, yetersiz servikal sitolojili ve yüksek riskli insan papilloma virüsü (HPV) pozitifliği olan kadınların kolposkopik biyopsi sonuçlarının incelemektir.
Gereç ve Yöntemler: Bu retrospektif çalışmada Mart 2015-Ekim 2017 tarihleri arasında kliniğimize yönlendirilen yetersiz servikal sitoloji ve yüksek riskli HPV pozitifliği olan kadınlara kolposkopi eşliğinde servikal biyopsi ve endoservikal küretaj yapıldı. Hastalar HPV tiplerine göre gruplandırıldı. Endoservikal küretaj, servikal biyopsi ve servikal konizasyon sonuçları analiz edildi.
Bulgular: Yetersiz servikal sitolojisi ve yüksek riskli HPV pozitifliği olan 46 hasta 30 aylık dönemde bu çalışmaya dahil edildi. Yirmi bir hastada (% 45,7) HPV 16 ve/veya HPV 18 ve 25 hastada (% 54,3) “16 olmayan 18 olmayan” HPV yüksek risk alt tipi mevcuttu. Servikal biyopsi sonuçları 20 hastada (% 43.5) normal histopatoloji, dört hastada (% 8.7) "HPV etkisi", 17 hastada (% 37) düşük dereceli skuamöz intraepitelyal lezyon (L-SIL) ve 5 hastada (% 10.9) yüksek dereceli skuamöz intraepitelyal lezyon (H-SIL) olarak bildirildi. Endoservikal küretaj incelemesinde üç hastada H-SIL (% 6.5) ve yedi hastada L-SIL (% 15.2) tespit edildi. Yedi (% 15.2) hastaya H-SIL nedeniyle konizasyon yapıldı ve konizasyon materyelinde üç cerrahi sınırları negatif H-SIL ve dört L-SIL bildirildi.
Sonuç: Yetersiz servikal sitolojisi ve yüksek riskli HPV pozitifliği olan kadınlar için HPV alt tiplerinden bağımsız olarak H-SIL riski arttığından kolposkopi yapmak çok önemli görünmektedir.

References

  • 1. Bray F, Loos AH, McCarron P, Weiderpass E, Arbyn M, Moller H, et al. Trends in cervical squamous cell carcinoma incidence in 13 European countries: changing risk and the effects of screening. Cancer Epidemiol Biomarkers Prev. 2005;14(3):677-86.
  • 2. Nayar R, Wilbur DC. The Pap Test and Bethesda 2014. "The reports of my demise have been greatly exaggerated." (after a quotation from Mark Twain). Acta Cytol. 2015;59(2):121-32.
  • 3. Ransdell JS, Davey DD, Zaleski S. Clinicopathologic correlation of the unsatisfactory Papanicolaou smear. Cancer. 1997;81(3):139-43.
  • 4. Hock YL, Ramaiah S, Wall ES, Harris AM, Marston L, Marshall J, et al. Outcome of women with inadequate cervical smears followed up for five years. J Clin Pathol. 2003;56(8):592-5.
  • 5. Adams AL, Gidley J, Roberson J, Wang W, Eltoum I, Chhieng DC. Clinical significance of unsatisfactory conventional pap smears owing to inadequate squamous cellularity defined by the Bethesda 2001 criterion. Am J Clin Pathol. 2005;123(5):738-43.
  • 6. Nygard JF, Sauer T, Nygard M, Skare GB, Thoresen SO. CIN 2/3 and cervical cancer in an organised screening programme after an unsatisfactory or a normal Pap smear: a seven-year prospective study of the Norwegian population-based screening programme. J Med Screen. 2004;11(2):70-6.
  • 7. Gultekin M, Zayifoglu Karaca M, Kucukyildiz I, Dundar S, Boztas G, Semra Turan H, et al. Initial results of population based cervical cancer screening program using HPV testing in one million Turkish women. Int J Cancer. 2018;142(9):1952-8.
  • 8. Gultekin M, Dundar S, Keskinkilic B, Turkyilmaz M, Ozgul N, Yuce K, et al. How to triage HPV positive cases: Results of four million females. Gynecol Oncol. 2020;158(1):105-11.
  • 9. Bornstein J, Bentley J, Bosze P, Girardi F, Haefner H, Menton M, et al. 2011 colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy. Obstet Gynecol. 2012;120(1):166-72.
  • 10. Solomon D, Davey D, Kurman R, Moriarty A, O'Connor D, Prey M, et al. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA. 2002;287(16):2114-9.
  • 11. Mirzamani N, Chau K, Rafael O, Shergill U, Sajjan S, Sumskaya I, et al. Quality assessment and improvement of "Unsatisfactory" liquid-based cervicovaginal papanicolaou smears. Diagn Cytopathol. 2017;45(10):873-7.
  • 12. Massad LS, Einstein MH, Huh WK, Katki HA, Kinney WK, Schiffman M, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2013;17(5 Suppl 1):S1-S27.
  • 13. Zhao C, Austin RM. High-risk human papillomavirus DNA test results are useful for disease risk stratification in women with unsatisfactory liquid-based cytology pap test results. J Low Genit Tract Dis. 2009;13(2):79-84.
  • 14. Owens CL, Buist DS, Peterson D, Kamineni A, Weinmann S, Ross T, et al. Follow-up and clinical significance of unsatisfactory liquid-based Papanicolaou tests. Cancer Cytopathol. 2015;123(1):59-65.
  • 15. Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis. 2020;24(2):102-31.

Analysis of colposcopic findings of high-risk HPV positive women with unsatisfactory cervical cytology

Year 2021, Volume: 18 Issue: 1, 702 - 706, 01.04.2021
https://doi.org/10.38136/jgon.846750

Abstract

Aim: We aimed to analyze the colposcopic directed biopsy results of women with unsatisfactory cervical cytology and high-risk human papilloma virus (HPV) positivity, who were referred to the Gynecologic Oncology outpatient clinic from Cancer Early Diagnosis and Screening Centers.
Materials and Methods: In this retrospective study, women with high-risk HPV subtypes who applied to our clinic between March 2015 and October 2017 with an inadequate cervical cytology underwent colposcopy-directed biopsy. Patients were grouped according to HPV types. The results of endocervical curettage, cervical biopsy, and cervical conization were analyzed.
Results: Forty-six patients with unsatisfactory cervical cytology and high-risk HPV were included in this study during the 30-month period. Twenty-five (54.3%) of the patients had “non-16 non-18” HPV subtypes, while 21 (45.7%) had HPV 16 and/or HPV 18. Cervical biopsy results revealed high-grade squamous intraepithelial lesion (H-SIL) in 5 (10.9%) patients, low-grade squamous intraepithelial lesion (L-SIL) in 17 (37%), “HPV effect” in 4 (8.7%) and normal histopathology in 20 (43.5%) patients. The endocervical curettage revealed three (6.5%) women with H-SIL and seven (15.2%) with L-SIL. Seven (15.2%) patients underwent conization due to H-SIL and there were three H-SIL with negative margins and four L-SIL in the final histopathology report.
Conclusion: Performing colposcopy seems to be crucial for women with inadequate cervical cytology and high-risk HPV regardless of HPV subtypes as there is an increased risk of H-SIL in this patient population.

References

  • 1. Bray F, Loos AH, McCarron P, Weiderpass E, Arbyn M, Moller H, et al. Trends in cervical squamous cell carcinoma incidence in 13 European countries: changing risk and the effects of screening. Cancer Epidemiol Biomarkers Prev. 2005;14(3):677-86.
  • 2. Nayar R, Wilbur DC. The Pap Test and Bethesda 2014. "The reports of my demise have been greatly exaggerated." (after a quotation from Mark Twain). Acta Cytol. 2015;59(2):121-32.
  • 3. Ransdell JS, Davey DD, Zaleski S. Clinicopathologic correlation of the unsatisfactory Papanicolaou smear. Cancer. 1997;81(3):139-43.
  • 4. Hock YL, Ramaiah S, Wall ES, Harris AM, Marston L, Marshall J, et al. Outcome of women with inadequate cervical smears followed up for five years. J Clin Pathol. 2003;56(8):592-5.
  • 5. Adams AL, Gidley J, Roberson J, Wang W, Eltoum I, Chhieng DC. Clinical significance of unsatisfactory conventional pap smears owing to inadequate squamous cellularity defined by the Bethesda 2001 criterion. Am J Clin Pathol. 2005;123(5):738-43.
  • 6. Nygard JF, Sauer T, Nygard M, Skare GB, Thoresen SO. CIN 2/3 and cervical cancer in an organised screening programme after an unsatisfactory or a normal Pap smear: a seven-year prospective study of the Norwegian population-based screening programme. J Med Screen. 2004;11(2):70-6.
  • 7. Gultekin M, Zayifoglu Karaca M, Kucukyildiz I, Dundar S, Boztas G, Semra Turan H, et al. Initial results of population based cervical cancer screening program using HPV testing in one million Turkish women. Int J Cancer. 2018;142(9):1952-8.
  • 8. Gultekin M, Dundar S, Keskinkilic B, Turkyilmaz M, Ozgul N, Yuce K, et al. How to triage HPV positive cases: Results of four million females. Gynecol Oncol. 2020;158(1):105-11.
  • 9. Bornstein J, Bentley J, Bosze P, Girardi F, Haefner H, Menton M, et al. 2011 colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy. Obstet Gynecol. 2012;120(1):166-72.
  • 10. Solomon D, Davey D, Kurman R, Moriarty A, O'Connor D, Prey M, et al. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA. 2002;287(16):2114-9.
  • 11. Mirzamani N, Chau K, Rafael O, Shergill U, Sajjan S, Sumskaya I, et al. Quality assessment and improvement of "Unsatisfactory" liquid-based cervicovaginal papanicolaou smears. Diagn Cytopathol. 2017;45(10):873-7.
  • 12. Massad LS, Einstein MH, Huh WK, Katki HA, Kinney WK, Schiffman M, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2013;17(5 Suppl 1):S1-S27.
  • 13. Zhao C, Austin RM. High-risk human papillomavirus DNA test results are useful for disease risk stratification in women with unsatisfactory liquid-based cytology pap test results. J Low Genit Tract Dis. 2009;13(2):79-84.
  • 14. Owens CL, Buist DS, Peterson D, Kamineni A, Weinmann S, Ross T, et al. Follow-up and clinical significance of unsatisfactory liquid-based Papanicolaou tests. Cancer Cytopathol. 2015;123(1):59-65.
  • 15. Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis. 2020;24(2):102-31.
There are 15 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Research Articles
Authors

Ayçağ Yorgancı 0000-0003-2565-6789

Mustafa Erkan This is me 0000-0003-1202-9823

İlker Selcuk 0000-0003-0499-5722

Hakan Raşit Yalçın 0000-0002-9027-1351

Tayfun Güngör 0000-0002-7869-9662

Mehmet Mutlu Meydanlı 0000-0001-6763-9720

Publication Date April 1, 2021
Submission Date December 25, 2020
Acceptance Date February 9, 2021
Published in Issue Year 2021 Volume: 18 Issue: 1

Cite

Vancouver Yorgancı A, Erkan M, Selcuk İ, Yalçın HR, Güngör T, Meydanlı MM. Analysis of colposcopic findings of high-risk HPV positive women with unsatisfactory cervical cytology. JGON. 2021;18(1):702-6.