HPV Testi Pozitif, Servikal Sitolojisi Negatif Hastaların Kolposkopi Sonuçlarının Değerlendirilmesi

Öz

Servikal sitolojisi malignite açısından negatif, HPV (Human papillomaVirus) DNA taraması pozitif olan hastalarda tek başına HPV pozitifliğinin preinvaziv/invaziv hastalığı tanımlayabilmedeki yerini araştırmaktır. Ulusal Kanser Erken Teşhis, Tarama ve Eğitim Merkezi (KETEM) tarafından 30-65 yaş arasında primer HPV testi ile taranıp refleks sitoloji uygulanan ve Ocak 2021- Aralık 2021 tarihleri arasında kolposkopik değerlendirme yapılan hastalar retrospektif tarandı. Servikal sitolojisi negatif, HPV pozitif olan 234 hasta çalışmaya dahil edildi. Hastalar HPV sonuçlarına göre 4 gruba ayrıldı; HPV 16 ve/veya 18 pozitifler, HPV 16/18 ile birlikte diğer yüksek riskli HPV pozitifler, sadece diğer yüksek riskli HPV pozitifler, düşük riskli HPV pozitifler. Gruplar demografik veriler, kolposkopik sonuçlar açısından karşılaştırıldı. 234 hastanın mediyan yaşı 44(38-52), paritesi 2(2-3)idi. Hastaların 82’si (%35) postmenopozal iken,152 (%65) tanesi premenopozaldi. Gruplar arasında yaş, vücut kitle indeksi, gravida, parite, menopozal durum, sigara kullanımı, kolposkopik muayenede anormal bulguların bulunma oranı, uygulanan biyopsi adedi açısından fark izlenmedi. HPV sıklık sırası HPV16 (%29,6), HPV31 (%17,5), HPV52 (%9,8), HPV51(%9,4) ve HPV18 (%8,1)idi. Kolposkopik biyosi histopatolojik sonuçlarına göre, HPV 16 ve/veya 18 pozitifliğinde prekanseröz lezyon (CIN 2-3) görülme oranı diğer gruplara göre yüksekti (p=0,007). Endoservikal küretaj (ESK) histopatoloji sonuçlarına göre 2 hastada invaziv kanser varlığı saptandı. Sitoloji normal olan hastalarda HPV DNA pozitifliği endikasyonu ile yapılan kolposkopik biyopsilerde yüksek dereceli servikal displazi ve kanser görülebilmektedir. Yüksek onkojenik HPV alt tiplerinin (HPV 16- 18) direkt kolposkopiye yönlendirilmesi gerekmektedir. Aşılama programlarının yaygınlaşması ile HPV 31 gibi diğer yüksek riskli alt tipler ilerleyen yıllarda klinik önem kazanabilir.

Anahtar Kelimeler

• HPV
• servikal sitoloji
• kolposkopi
• yükek riskli HPV

Evaluation of Colposcopy Results of HPV Test Positive and Cervical Cytology Negative Patients

Öz

To investigate the role of HPV(Human papillomaVirus) positivity alone in defining preinvasive/invasive disease in patients with negative cervical cytology for malignancy and positive HPVDNA screening. Patients aged 30-65 years, who were screened with primary HPV test and reflex cytology by the National Cancer Early Diagnosis, Screening and Education Center (KETEM), and who underwent colposcopic evaluation between July 2021 and March 2022, were retrospectively screened. 234 patients with negative cervical cytology and positive HPV were included in the study. The patients were divided into 4 groups according to HPV results; HPV 16 and/or 18, HPV 16/18 together with other high-risk HPV, only other high-risk HPV, low-risk HPV. Groups were compared in terms of demographic data and colposcopic results. The median age was 44(38-52). While 82(35%) of the patients were postmenopausal, 152(65%) were premenopausal. There was no difference between the groups in terms of age, body mass index, gravida, parity, menopausal status, smoking, the rate of abnormal findings in colposcopic examination, and the number of biopsies performed. The frequencies of HPV types were HPV16 (29.6%), HPV31 (17.5%), HPV52 (9.8%), HPV51 (9.4%) and HPV18 (8.1%). According to colposcopic biopsies, the rate of precancerous lesion in HPV 16 and/or 18 positivity was higher than other groups(p=0.007). According to endocervical curettage, invasive cancer was detected in two patients. High-risk oncogenic HPV subtypes (HPV 16-18) should be referred to colposcopy. With the spread of vaccination programs, other high-risk subtypes such as HPV type 31 may gain clinical importance in the upcoming years.

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