Eş zamanlı servikal sitoloji örneklerinde yüksek riskli HPV tiplerinin varlığı ve dağılımı

Öz

Amaç: Human papillomavirus, reprodüktif sistemin en sık görülen viral enfeksiyon etkenidir ve neredeyse tüm serviks kanseri olgularıyla ilişkisi gösterilmiştir. Servikal kanser tarama programları ile erken tanı ve tedavi sayesinde insidans ve mortalite oranları etkin şekilde azalmaktadır. Bu çalışmada üç yıllık bir süre içinde çalışılan HPV DNA test sonuçları ve eş zamanlı servikal sitoloji örneklerinin değerlendirilmesi amaçlanmıştır. Yöntem: 2012-2014 yılları arasında Moleküler Mikrobiyoloji Laboratuvarı’na HPV DNA araştırılması ve genotip tayini amacıyla gönderilen 328 hastaya ait tesrt sonuçları retrospektif olarak analiz edilmiştir. Hastaların sitoloji sonuçları eş zamanlı olarak patoloji laboratuvarı tarafından retrospektif olarak değerlendirilmiş, gerek duyulan örnekler tekrar incelenerek servikal anormallikler ile HPV varlığı ve genotipler arasındaki ilişkiler ortaya konulmuştur. Servikal örnek alımında DigeneHC2 DNA Collection Device® kullanılmış ve DNA eldesi QIAamp® DNA Mini Kit ile yapılmıştır. DNA örneklerinde yüksek riskli HPV tiplerinin varlığı Genotyping Kit HPV GP kullanılarak araştırılmıştır. Sitolojik değerlendirme konvansiyonel Papanicolau testi ile yapılmış ve sonuçlar 2001 Bethesda Sistemi’ne göre yorumlanmıştır. Bulgular: Hastaların yaş ortancası 36 olup, test sonucu pozitif ve negatif kadınların yaş ortancaları arasında anlamlı fark bulunmamıştır. Yüksek riskli HPV DNA analizi yapılan 328 hastanın 110 tanesinde %33.5 pozitif sonuç elde edilmiş ve %22.7 oranında multiple tip varlığı bulunmuştur. En sık saptanan tipler HPV16/51/18/56 olarak belirlenmiştir. Hastaların 270’inde eş zamanlı sitolojik değerlendirme yapılmış ve %21.5 anormal sitoloji saptanmıştır. Anormal sitoloji saptanan hastaların sitolojik bulgulara göre dağılımı; %48.3 ASCUS, %34.5 LSIL, %7 ASC-H, %7 HSIL ve %3.5 AGUS şeklinde olmuştur. Anormal sitoloji saptanan hastalardaki HPV pozitifliği %50 , normal sitolojili hastalardaki HPV pozitifliğinden %28.3 istatistiksel olarak anlamlı derecede yüksek bulunmuştur p=0.002 . Çalışmamızda Tip 16, anormal sitolojili grupta %38, normal sitolojili grupta ise %44 oranında saptanmıştır. Sonuç: Servikal kanser tarama programları tüm dünyada hızla önem kazanırken, HPV genotipleme önemli rol üstlenmektedir. Normal sitolojili hastalarda da Tip 16’nın yüksek oranda saptanması, sitolojik incelemenin mutlaka DNA çalışması ile desteklenmesi ve hastaların yakın takibe alınması gerekliliğini kanıtlamaktadır.

Anahtar Kelimeler

• servikal kanser, sitoloji, yüksek riskli HPV

The presence and distribution of high risk HPV types in simultaneous cervical cytology samples

Abstract

Objective: Human papillomavirus HPV is the most detected viral pathogen of reproductive system and almost all servical carsinomas are related to HPV. The incidance and mortality rate of cervical carsinomas are significantly decrease by means of early diagnosis and treatment owing to servical cancer screening programmes. The aim of the study is to evaluate the results of HPV DNA tests and cervical cytology specimens simultaneously in a three year period. Methods: The test results of 328 patients that were send to determine Molecular Microbiology Laboratory for HPV DNA and genotype between 2012-2014 were retrospectively analysed. Moreover, the cytology results of the same patient group were reviewed simultaneously by pathologist and reexamined if necessary. The relationship between cervical anomalies and the presence of HPV DNA and genotypes were exhibited. Cervical samples were collected in DigeneHC2 DNA Collection Device and DNA was isolated using QIAamp DNA Mini Kit. DNA samples were tested for high risk HPV infection by the Genotyping Kit HPV GP. Cytological examination were done by using conventional Papanicolaou method and interpreted according to 2001 Bethesda System.Results: The median age of the patients was found 36 and there was no significant difference between the median ages of the HPV DNA negative and positive women. High risk HPV DNA was determined 110 out of 328 patients 33.5% and multiple types were detected 22.7% of the cases. The most determined types were HPV-16/51/18 and 56 respectively. Abnormal cytology was detected from 21.5% of the 270 patients that were evaluated by pathologist simultaneously. The abnormal cytologic signs of the patients were reported as 48.3% ASCUS, 34.5% LSIL, 7% ASC-H, 7% HSIL and 3.5% AGUS. The HPV DNA positivity of the patients with abnormal cytologic results 50% were found high significantly comparing the patients with normal cytology 28.3% p=0.002 . The type 16 was determined 38% and 44% from the patients with abnormal and normal cytology, respectively. Conclusion: The genotyping of HPV plays an important role while the cervical cancer screening programmes have gaining importance globally. The determination of high rates of type 16 from patients with normal cytology proves that cytologic evaluation should be supported by DNA typing and those patients should be followed up closely.

Keywords

• cervical cancer, cytology, high risk HPV

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