Management of abnormal cytology results and correlation of cytopathologic results accompanied by colposcopy in our clinic.

Abstract

Aim: Pap smear test is a major screening test for early diagnosis and treatment of cervix cancer. The aim of our study was to assess the value of colposcopy and histopathologic examination in the management of patients with abnormal cervical cytology by Bethesda Classification.

Methods: In this study, we aimed to compare and evaluate the diagnosis of 12,381 cytology material examined in our gynecology clinic during the years between 2014 and 2016 with their cytopathology results.

Results: 498 of 12,381 patients had abnormal cytological findings (4.02%). The rates of Atypical Squamous Cells of Undetermined Significance (ASC-US), Atypical Glandular Cells of Undetermined Significance (AG-US), Low Grade Squamous Intraepithelial Lesions (LG-SIL) and High Grade Squamous Intraepithelial Lesions (HG-SIL) were found to be 1.9%, 0.4%, 1% and % 0.1, respectively. Atypical squamous cell cannot exclude HSIL (ASC-H) rate were found as % 0.4. The rate of abnormal cytology in cervical intraepithelial lesions was 2.1. Positive predictive values of abnormal smear results were 21.7% for ASC-US, 41.9% for LGSIL, 100% for HGSIL, 12.5% for AGUS and 50% for ASC-H.

Conclusion: The Pap smear test is a cheap and easily applied screening test. Early diagnosis of cervix cancer can be made by routine Pap smear testing. The efficiency in clinical use of the cervical cytology screening test is determined by biopsy verification. As the ratio of epithelial cell abnormality is variable in different populations, the ASC (Atypical Squamous Cell) / SIL (Squamous Intraepithelial Lesion) is a more definite variable to be used for quality assurance.

Keywords

• Colposcopy,Cytology,Cervical Smears

Kliniğimizdeki anormal servikal smear sonuçlarının yönetimi ve kolposkopi eşliğinde alınan sitopatoloji sonuçlarının korelasyonu

Öz

Amaç: Pap smear testi serviks kanserinin erken tanı ve tedavisinde çok önemli bir tarama yöntemidir. Bu çalışmanın amacı, smear testinde anormallik saptanan olguların yönetiminde kolposkopi ve patolojik incelemenin öneminin belirlenebilmesidir.

Yöntemler: Bu çalışmada 2014-2016 yılları arasında Düzce Atatürk Devlet Hastanesi Jinekoloji Polikliniği’ne başvuran 12.381 hastanın Bethesda sınıflamasına göre Pap Smear testi sonuçları ve kolposkopi eşliğinde alınan sitopatoloji sonuçları değerlendirilmiş ve karşılaştırılmıştır.
Bulgular: 12.381 olgunun 498’inde anormal sitolojik bulgular saptandı (% 4,02). Anormal sitolojilerin içerisinde önemi bilinmeyen hücreler (ASCUS) % 1,9, Atipik Glanduler Hücreler (AGUS) % 0,4, Düşük Dereceli Skuamöz İntraepitelyal Lezyon (LGSIL) %1, Yüksek Dereceli İntraepitelyal Lezyon (HGSIL) % 0,1, Atipik Skuamöz Hücrelerin Dışlanmadığı Grup (ASC-H) % 0,4 olarak saptanırken, anormal sitolojilerin servikal intraepitelyal lezyonlara oranı 2,1 olarak saptandı. Pap Smear’de anormal sitolojik bulgu saptanan olguların pozitif öngörü değerleri ASCUS için %21,7, LGSIL için %41,9, HGSIL için %100, AGUS için %12,5 ve ASC-H için %50 olarak hesaplandı.
Sonuç: Pap Smear testi, ucuz ve kolay bir yöntemdir. Serviks kanserinin erken tanısı Pap smear testi sayesinde mümkündür. Servikal sitolojinin klinik uygulamalarda güvenilir şekilde kullanımı ise biyopsi doğrulaması ile mümkündür. Farklı toplumlarda epitel hücre anomalisi oranı değişken olabildiği için atipik skuamöz hücre  (ASH) / servikal skuamöz intraepitelyal lezyon (SIL) oranı kalite yöntemi açısından daha net bir veri olarak değerlendirilmektedir.  

Anahtar Kelimeler

• Kolposkopi,Servikal Smear,Sitoloji

Kaynakça

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