Minimal anormal smear bulgusu olan olgularda kolposkopik analiz

Year 2002, Volume: 33 Issue: 4, 11 - 16, 01.05.2002

Funda Ayşe Platin Bülent Tandoğan Vedat Dayıcıoğlu

Abstract

Amaç: Minimal anormal smear bulgusu ASCUS (Önemi belirsiz atipik skuamoz hücreler), LGSIL (Düşük grade'li skuamoz intraepitelyal lezyon) olan grupta kolposkopinin gerekliliğini değerlendirmek. Materyal \e Metod: Çalışma prospektif olarak smear tarama sonucu 'Minimal' anormal smear olarak gelen 90 olgu üzerinde yapıldı. Olguların hepsi kolposkopik inceleme ile değerlendirildi. Şüpheli alanlardan biopsi örnekleri alındı ve ECC yapıldı. 6 ay sonra smearleri tekrarlandı. Bulgular: Minimal anormal smear bulgusu olan 90 hasta %75.6'sı ASCUS, %24.4 LGSIL grubundandı. Bu hastaların kolposkopileri yapıldı. %18.9 normal, %79.9 anormal, %2.2 yetersiz kolposkopik bulgu olarak değerlendirildi. Anormal kolposkopisi olan gruba yapılan biopsi sonuçlanna göre %25 CIN I, %3 CIN II-CIN III saptandı. Toplam %28 CIN tespit edildi. Sonuçlar: Minimal anormal smear bulgusu olan hastalarda saptanan yüksek oranda CIN sebebiyle bu olgularda acil kolposkopi yapmak ve sonucuna göre agresif yaklaşımda bulunmak gereklidir.

Keywords

Kolposkopi, İleriye dönük çalışma, Vajinal smirler, Tanı teknikleri, kadın doğum ve kadın hastalıkları

Colposcopic analysis of cases who have minimally abnormally abnormal cervical smear

Abstract

Objective: To evaluate the importance of colposcopy in cases who have minimally abnormal smear results. Materials and Methods: This Study, 90 cases who have minimally abnormal smear results has been studied prospectively, all cases have been examined with colposcopy and biopsies were taken from suspected areas and endocervical curretage has been performed and six months later smears were repeated. Results: 75.6 percent of 90 cases who have minimally abnormal smear were detected as ASCUS and 24.4 percent were detected as LGSIL. Colposcopic examination has been performed on these patients and 18.9 percent has been found normal, 79.9 percent has been reported as undetectable transformation zone. According to the biopsy results of the cases who have abnormal colposcopy 25 percent was CIN I, 3 percent was CIN II-III. As a total 28 percent CIN was detected. Conclusion: Because of the high CIN rate among the cases who have minimally abnormal smear, colposcopy must be performed as soon as and according to the results aggressive approach is recommended.

Keywords

Colposcopy, Prospective Studies, Vaginal Smears, Diagnostic Techniques, Obstetrical and Gynecological

References

• 1. Berkman S, Ermiş H. Servikal intraepitelyal neo- plazi, Atasü T, Aydınlı K; Jinekolojik Onkoloji
• Logos, İstanbul 1996; 229-249
• 2. Bengisu E, Ermiş H, Tuncer Z. Serviksin benign lezyonları; Temel Kadın Hastalıkları ve Doğum Bilgisi. Güneş Kitabevi Ankara 1996 : 788-800
• 3. Disaia PJ, Creasman WT . Preinvazive disease of cervix in Clinic Gynecologic Oncology,Saint Louis Mosby- Year Book 1997: 7-15
• 4. Howell LP, Davis RL . Follow-up Papanicoloau smears diagnosed as Atypical squamous cells of undetermined significance, Diagnostic Cytopathology 1996;14: 20-24
• 5. Soutter WP, Fletcher A. invasive cancer of the cervix in women with mild dyskaryosis followed-up cytologically. Br. MedJ 1994; 308: 1421-23
• 6. Kurman RJ, Henson DE, Herbst AL, Noller KL, SOchiffman MH. interim guidelines for management of Abnormal cervical cytology. JAMA 1994; 271: 1866-69
• 7. Kiviat N. Natural history of cervical neoplasia: overview and update. Am. J.Obstet. Gynecol
• 1996 ; 175: 1099-1104
• 8. Melnikow J, Nuovo J, Willian AR, Chan BK, Howell LP. Natural history of cervical squamous intraepithelial lesions \ a meta-analysis. Obstet Gynecol. 1998; 92; 727-734
• 9. Montz FJ, Monk BJ, Fowler JM, Nguyen L
• Natural history of the minimally Abnormal papan¬ icoloau smear. Obstet Gynecol, Sep 1992; 80: 385-388
• 10. Wright T, Sun XW, Koulos J. Comparison of management Algorithms for the evaluation of women with Low-grade cytologic Abnormalities
• Obstet Gynecol 1995; 85: 202-210
• 11. Davis GL, Hernandez E, Davis JL, Miyazawa K
• Atypical squamous cells in papanicoloau smears
• Obstet Gynecol 1987; 69 : 43-46 12. Lindheim SR, Smith-Nguyen G. Aggressive eval¬ uation for atypical squamous cells in papanicoloau smears. J. Reprod Med 1990 ; 35 : 971-973
• 13. Baldauf JJ, Cuenin C, Ritter J. Long term progress of Low-grade intraepithelial lesions after a smear amd colposcopy, directed biopsies and / or normal endocervical curettage. Contracept Fertil Sex 1999 ; 27 : 774-779
• 14. Jones M.H, Jenkins D, Cuzick J, Wolfendale M.R, Jones JJ et all. Mild cervical dyskaryosis; safety of cytological surveillance. Lancet 1992; 339: 1440- 1443
• 15. Flannelly G, Anderson D, Kitchener H.C et all
• Management of women with mild and moderate cervical dyskaryosis. British Med. Journal 1994;308:1399-1403
• 16. Rader A, Rose P, Rodriquez M et all; Atypical squamous cells of undetermined significance in women over 55. Acta Cytologica 1999; 43: 357-362
• 17. Me Cormick J. Cervical smears: A questionable practice? Lancet 1989;238: 207-209
• 18. Smith A. Cervical cytology serening. Br. Med. J 296; 1670
• 19. Compion MJ, Brown Jr, Me Cance DJ , Atia W , Edwards R , Cuzick J , Singer A. Psychosexual trau¬ ma of an abnormal cervical smear. Br. J. Obstet gynecol 1988; 95: 175-181
• 20. Campion MJ, Me Cance DJ, Cuzick J . Singer A
• Progressive potential of mild cervical atypia; prospective cytological, colposcopic, and virological study: Lancet; 1986 ; 237-240
• 21. Jones MH. The management dilemna of the mildly abnormal smear:fact or fiction?: Ann Acad Med Singapore 1998; 27:666-670
• 22. Cenci M, Chieppa A, Vecchione A. Contraversial categories in cytopathology of the uterine cervix.I.ASCUS:atypical squamous cells of undetermined significance. Minerva Ginecol 2001;53:49-55
• 23. Simsir A, Ooffe OB, Bourquin P, Brooks SE, Henry M. Repeat cervical cytology at the time of colposcopy. Is there an added benefit? Acta Cytol 2001; 45:23-27
• 24. Zardawi IM, Rode JW. Clinical value of repeat Pap smear at the time of colposcopy.Acta Cytol 2002;46:495-498
• 25. Wright TC, Cox JT, Massad LS, Twiggs LB, Wilkinson EJ. ASCCP-Sponsored Consensus Conference. 2001 Consensus Guidelines for the management of women with cervical cytological abnormalities. JAMA 2002 ; 24: 2120-2129