Clinical evaluation of atypical squamous cells of undetermined significance diagnosed by cervical cytological screening: Eskisehir experience

Abstract

Purpose : Aim of our study is to compare the colposcopic findings with the histopathologic results of atypical squamous cells of undetermined significance (ASCUS) diagnosed during cervical cytological screening in patients applied with various complaints and evaluated with co-test so as to to determine the clinical value of it. Materials and Methods: In this retrospective analysis 177 patients who attended between January 2011 and may 2020, aged between 24-74 years, with the result of ASCUS in their Pap smear tests, were enrolled. Colposcopic findings of cases were classified according to Reid Colposcopic Index (RCI) and compared with the histopathologic results. Results: 177 patients were analyzed and the mean age of them was 37,1±1,41 (24-74), parity 2,8±1.07 (0-11) and mean smoking was found to be 6 cigarettes/day (0-40 cigarettes/day). 148 (%83,6) of cases were in premenapouse, 29 (%16,3) of them were in postmenapousal period. 68 (%38,4) patients were diagnosed as chronic cervicitis by colposcopy assisted cervical biyopsy, rest 108 (%61,0) were determined as cervical intraepithelial lesions (CIN) [85 (%48) CIN 1, 16 (%9) CIN 2, 7 (%3,9) CIN 3] and 1(%0,5) patient was found to be cervical carcinoma (CX CA). Comparison between HPV DNA types and RCI with biopsy results was analyzed with Pearson Exact Chi-square test and found to be statistically significant between groups (p<0.001). Conclusion: Our results put forth that colposcopic evaluation is needed in patients with cytologic ASCUS results even if HR-HPV DNA test is negative. That's why Pap smear test cannot be replaced by screening only with HR-HPV DNA, co-test requirement showed to be more suitable because of cytologic evaluation involvement.

Keywords

• ASCUS
• colposcopy
• HPV
• Reid Index

Servikal kanser taramasında saptanan önemi belirlenemeyen atipik skuamoz hücrelerin klinik değerlendirmesi: Eskişehir deneyimi

Öz

Özet Amaç: Çalışmamızın amacı çeşitli şikayetlerle başvuran, daha önce servikal lezyon tanısı almamış, smear sonucu önemi belirlenemeyen atipik squamoz hücreler (ASCUS) olup, co-test yapılmış olguların kolposkopik bulguları ile histopatolojik sonuçlarını karşılaştırıp, ASCUS tanısının klinikteki önemini ortaya koymak. Gereç ve Yöntem: Retrospektif analize Ocak 2011 - Mayıs 2020 tarihleri arasında Pap smear test sonucu ASCUS çıkan,  24-74 yaş arasında, kolposkopik biyopsi yapılıp, HPV DNA genotip tayini olan 177 hasta dahil edildi. Olguların kolposkopik bulguları Reid Kolposkopi İndeksine (RCI) göre sınıflandırıp, histopatoloji sonuçları ile karşılaştırıldı. Bulgular: İncelenen 177 hastanın yaş ortalaması 37,1±1,41 (24-74), parite 2,8±1.07 (0-11) ve sigara kullanımı ortalama 6 adet/gün (0- 40 adet/gün) olarak saptandı. Olguların 148'i (%83,6) premenopoz, 29'u (%16,3) postmenopoz dönemde idi. Kolposkopi eşliğinde biyopsi yapılan 68 olguya (%38,4) kronik servisit teşhisi konmuş olup, geriye kalan 108 (% 61,0) hastada servikal intraepitelyal lezyonlar (CIN) [85 (%48) CIN 1, 16 (%9) CIN 2, 7 (%3,9) CIN 3] ve 1(%0,5) olguda da servikal karsinom (CX CA) tespit edildi. Hastaların HPV DNA tiplendirme ve RCI ile biyopsi sonuçları karşılaştırıldığında Pearson Exact (Kesin) Ki-Kare testi ile gruplar arasında istatiksel olarak farklılık anlamlı bulundu (p<0.001). Sonuç: Bulgularımız ASCUS saptanan olgularda, HPV DNA testi negatif olsa da kolposkopik inceleme endikasyonu olduğunu göstermektedir. Bu nedenle çalışmamız tek başına HR-HPV taramasının smear testinin yerini alamayacağını, sitolojik incelemenin de yapıldığı co-testin tanı ve tedavi amaçlı daha uygun olduğunu göstermektedir.

Anahtar Kelimeler

• ASCUS
• kolposkopi
• HPV
• Reid İndeksi

References

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