SMILE, Servikal İntraepitelyal Neoplazi 3 ve Adenokarsinoma in situ Hastalarının Klinikopatolojik Değerlendirilmesi

Year 2025, Volume: 16 Issue: 3, 625 - 633, 30.09.2025

Işık Sözen , Hilal Serap Arslan , Gözde Şahin , Yasemin Aboalhasan , Elif Dila Tasti , İlkbal Temel

https://doi.org/10.18663/tjcl.1788113

Abstract

Amaç: SMILE, CIN3 ve AIS tanılı hastalarda servikal biyopsi sonuçlarının konizasyon/histerektomi sonrası kesin patolojik tanılarla uyumunu ve klinik özelliklerdeki farklılıkları karşılaştırmak.
Yöntemler: Tek merkezli retrospektif bir çalışma kapsamında SMILE (n=8), CIN3 (n=16) veya AIS (n=14) tanısı alarak cerrahi tedavi uygulanmış hastaların klinikopatolojik verileri incelenmiştir. Hastaların HPV genotip sonuçları, sitoloji (Pap smear) bulguları, uygulanan cerrahi işlemler ve cerrahi örneklerin patoloji sonuçları retrospektif olarak kayıt edildi.
Bulgular: HPV yüksek riskli genotip dağılımı ve sitolojik tanılar gruplar arasında benzer bulundu (p>0.05). AIS tanılı hastalarda ilk tedavide veya yeniden cerrahi sonrası histerektomi uygulanma oranı diğer gruplara kıyasla daha yüksekti. Biyopsi ön tanısı ile cerrahi eksizyon sonrası patoloji tanısının uyumu lezyon tiplerine göre anlamlı farklılık gösterdi (p<0.001). İkinci bir cerrahi girişim gereksinimi AIS ve CIN3 olgularında, SMILE olgularına göre anlamlı olarak daha sık izlendi (p=0.011). Bununla birlikte, tekrar cerrahi yapılan hastalarda elde edilen nihai patoloji sonuçları gruplar arasında belirgin bir fark göstermedi.
Sonuç: SMILE, CIN3 ve AIS olgularında HPV tipleri ve sitoloji sonuçları benzer olsa da biyopsi ile cerrahi patoloji uyumu özellikle glandüler lezyonlarda (AIS ve SMILE) değişkenlik gösterebilir. AIS ve CIN3 olgularında cerrahi sınır pozitifliği veya yetersiz tedavi nedeniyle ikinci bir cerrahi girişime ihtiyaç duyma oranının yüksek oluşu, bu lezyonlarda tedavi planlanırken dikkatli olunması gerektiğini göstermektedir.

Keywords

Servikal sitoloji , kolposkopi , biyopsi , uyum , servikal intraepitelyal neoplazi , Adenokarsinoma in situ , SMILE

Clinicopathological Evaluation of Patients with SMILE, Cervical Intraepithelial Neoplasia 3, and Adenocarcinoma in Situ

Abstract

Aim: To compare cervical biopsy diagnoses with final surgical pathology results among patients with SMILE, CIN3, and AIS, and to evaluate differences in clinical-pathological features between these lesions.
Methods: We performed a retrospective single-center analysis of patients diagnosed with SMILE (n=8), CIN3 (n=16), or AIS (n=14) who underwent surgical treatment. Clinical variables, high-risk HPV genotypes, cervical cytology findings, treatment modality, and pathological outcomes of surgical specimens were reviewed.
Results: The distribution of HPV high-risk genotypes and cytologic diagnoses were similar between the groups (p>0.05). The rate of hysterectomy performed during initial treatment or after reoperation was higher in patients with AIS compared to the other groups. The concordance between the preliminary biopsy diagnosis and the pathological diagnosis after surgical excision differed significantly across lesion types (p<0.001). The need for a second surgical intervention was significantly more common in AIS and CIN3 cases than in SMILE cases (p=0.011). However, the final pathological results obtained in patients who underwent reoperation did not show a significant difference between the groups.
Conclusion: Although the distribution of oncogenic HPV types and cytology findings were similar in SMILE, CIN3, and AIS, the agreement between biopsy and definitive surgical pathology was significantly different, highlighting diagnostic and management challenges especially for glandular lesions. The need for repeat surgical treatment was notably higher in AIS and CIN3 cases, underscoring the importance of thorough initial treatment and follow-up in these high-grade lesions.

Keywords

Cervical cytology , colposcopy , biopsy , concordance , cervical intraepithelial neoplasia , Adenocarcinoma in situ , SMILE

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