HPV burden and risk of CIN II or worse pathology in patients with atypical squamous cell of undetermined significance (ASCUS) cytology

Year 2023, Volume: 23 Issue: 2, 15 - 22, 06.11.2023

Ata Erdem Türk , Bahar Nur Şahin , Deniz Gökçe Yıldız , Ada Aray , Berkay Aksoyak , Zeynep Berra Şimşek , Tugba Tekelioglu , Hüseyin Akıllı Esra Kuşçu , Ali Ayhan

Abstract

Objective:The aim of the study was to evaluate the Human Papillomavirus(HPV) burden and the risk of Cervical Intraepithelial Lesion grade II(CIN-II) or worse pathology in patients with Atypical Squamous Cell of Undetermined Significance(ASCUS) cytology at the time of diagnosis. Matherial and Methods:The study included patients who have ASCUS cytology and underwent HPV testing between the years 2011-2021.Colposcopic biopsy were performed in patients with positive HPV.The patient's medical records and demographic information were evaluated retrospectively.The proportion of HPV positivity and the risk of CIN-II or worse pathology were evaluated by using SPSS package programme. Results:Median age was 39 years(22-73y).749 patients had HPV test and 353(47.1 %) of them was HPV positive. 68(10.7 %) patients had HPV-16, 44(7%) had HPV-52, 39(6%) had HPV-18 and 32(5.1%) had HPV-31.Eighty-eigth(11.7%) patients had HPV-16/18 and 90(12 %) had more than three HPV types. 369(51%) patients underwent cervical biopsy and 236(64%) of them had cervicitis or normal pathology.52(14.1%) patients had CIN-I ,22(6%) had CIN-II, 57(15.4%) had CIN-III and 2(0.5%) had Carcinoma in Situ. HPV-16 and/or 18 was found to increase the risk of the presence of CIN-II+ lesions in multivariate analysis(OR: 6.2, 95%CI 3.3-11.9, P=0.00).Sensitivity and specifity of HPV-16/18 for detecting CIN-II+ lesion was 54.7% and 83% respectively and the Negative Predictive Value(NPV) was 89% and Positive Predictive Value(PPV) was 56.7%. Conlusion:HPV positivity in the ASCUS population is relatively high in our institution and risk of CIN-II+ lesions sixfold increased with the presence of HPV-16/18.Moreover,HPV-16/18 testing has low PPV and high NPV in detecting CIN-II plus lesions

Keywords

Atypical Squamous Cells of Undetermined Significance (ASCUS), Human Papillomavirus(HPV), Cervical Intraepithelial Neoplasia II plus(CIN-II+), Cervical Cancer

Önemi Belirsiz Atipik Skuamöz Hücre (ASCUS) sitolojisi olan hastalarda HPV yükü ve CIN II veya daha kötü patoloji riski

Abstract

Amaç:Önemi belirsiz atipik skuamöz hücre(ASCUS) sitolojisi olan hastalarda tanı anında HPV yükü ve servikal intraepitelyal lezyon grad II(CIN II) veya üstü patoloji riskini değerlendirmektir. Gereç ve Yöntem:Çalışmaya 2011-2021 yılları arasında ASCUS sitolojisi olan ve Human Papillomavirus(HPV) testi yapılan hastalar dahil edildi. HPV testi pozitif olan hastalara kolposkopik biyopsi yapıldı. Hastanın tıbbi kayıtları ve demografik bilgileri geriye dönük olarak değerlendirildi. HPV pozitiflik oranı ve CIN II veya daha kötü patoloji riski SPSS paket programı kullanılarak değerlendirildi. Bulgular: Ortanca yaş 39(22-73) idi. 749 hastaya HPV testi uygulandı, 353'ünde(%47,1) HPV pozitifti. 68 hastada HPV-16(%10,7), 44(%7) hastada HPV-52, 39(%6) hastada HPV-18 ve 32(%5,1) hastada HPV-31 pozitifti. Seksen sekiz hastada (%11.7) HPV-16 /18 ve 90(%12) hastada üçten fazla HPV tipi pozitifti. 369(%51) hastaya servikal biyopsi yapıldı ve bunların 236(%64)'sında servisit veya normal patoloji vardı.52(%14,1) hastada CIN-I, 22(%6)'de CIN-II, 57(%15,4)'de CIN-III ve 2(%0,05) hastada carcinoma in situ saptandı. HPV Tip-16 ve/veya 18'in multivaryant analizde CIN-2+ lezyonlarının varlığı riskini artırdığı bulunmuştur(OR:6,2, %95 GA: 3,3-11,9, P=0,00). HPV-16/18 testinin CIN-2 + lezyonunu saptamada duyarlılık ve özgüllüğü sırasıyla %54,7 ve %83 olarak bulundu ve aynı test için Negatif Öngörü Değeri(NPV) %89 ve Pozitif Öngörü Değeri(PPV) %56,7 idi. Sonuç: Kurumumuzda ASCUS popülasyonunda HPV pozitifliği nispeten yüksektir ve HPV-16/18'in varlığı ile CIN-II+ lezyon riski altı kat artmıştır. Ayrıca, HPV-16/18 testi, CIN-II ve üstü lezyonları tespit etmede düşük PPV ve yüksek NPV'ye sahiptir.

Keywords

Önemi Belirsiz Atipik Skuamoz Hücre (ASCUS), Human Papillomavirus(HPV), Servikal İntraepitelyal Neoplazi II plus(CIN-II+), Serviks Kanseri

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