Vaginal Smear Test Results of Patients Presenting to Our Pathology Department Between 2011 and 2020 in the Middle Anatolia Region of Turkey

Yıl 2022, Cilt: 3 Sayı: 1, 45 - 52, 12.03.2022

Hasan İnal , Zeynep Ozturk Inal , İlknur Küçükosmanoğlu Meryem İlkay Eren Karanis

https://doi.org/10.48176/esmj.2022.49

Öz

Introduction: The objective of this study is to evaluate the cervical cytology results of patients who presented to the pathology laboratory of our hospital for vaginal smears between 2011 and 2020 according to the Bethesda 2014 classification.
Methods: The vaginal smear test reports of 121,537 patients who presented to our pathology laboratory between January 2011 and December 2020 were retrospectively reevaluated. The Bethesda 2014 classification was used for evaluating the results. The data obtained from electronic patient records and the Medical Pathology Department archives were assessed according to the years.
Results: The distribution of 121,537 admissions across the years was as follows: 2011: 7915; 2012: 12,211; 2013: 14,912; 2014: 11,907; 2015: 10,170; 2016: 12,234, 2017: 12,756, 2018: 12,846, 2019: 13,124, and 2020: 13,462. All were aged 17-65 years; the mean age was 46.52±11.85 years. Human papillomavirus (HPV) was detected in 3.3% of cases in 2020. The sample adequacy rate was 99.3%. Intraepithelial lesions and malignancy were not detected in 98.5%, the highest rate of inflammation was observed as 11.8%. Squamous cell anomalies constituted 1.3% of epithelial cell anomalies (1.5%). Among the squamous cell anomalies, prevalence of atypical squamous cells of undetermined significance was 0.86%, low-grade squamous intraepithelial lesions was 0.22%, suspected atypical squamous cell was 0.11%, high-grade squamous intraepithelial lesions was 0.08%, and squamous cell carcinoma was 0.01%. Diagnosis of atypical endocervical cells (0.01%) was the most common class of glandular cell anomalies, and endocervical adenocarcinoma (0.003%) was the least common.
Conclusion: Cervical smear and HPV DNA tests have an important role in defining cervical intraepithelial lesions. Regional and national screening programs should be used to prevent the transformation of precancerous lesions into invasive cancer.

Anahtar Kelimeler

cervical cancer, human papilloma virus, screening, vaginal smear

Türkiye'nin İç Anadolu Bölgesinde 2011-2020 Yılları Arasında Patoloji Bölümümüze Başvuran Hastaların Vajinal Smear Test Sonuçları

Öz

Giriş: Bu çalışma ile 2011-2020 yılları arasında hastanemiz patoloji laboratuvarına vajinal smear için başvuran hastaların servikal sitoloji sonuçlarını Bethesda 2014 sınıflamasına göre değerlendirmek amaçlandı.
Yöntemler: 2 Ocak 2011-Aralık 2020 tarihleri arasında patoloji laboratuvarımıza başvuran 121.537 hastanın vajinal smear testi raporları retrospektif olarak yeniden değerlendirildi. Sonuçların değerlendirilmesinde Bethesda 2014 sınıflaması kullanıldı. Elektronik hasta kayıtları ve Tıbbi Patoloji Anabilim Dalı arşivlerinden elde edilen veriler yıllara göre değerlendirildi.
Bulgular: 121.537 başvurunun yıllara göre dağılımı aşağıdaki gibiydi: 2011: 7915; 2012: 12.211; 2013: 14.912; 2014: 11.907; 2015: 10,170; 2016: 12.234, 2017: 12.756, 2018: 12.846, 2019: 13.124 ve 2020: 13.462. Olguların tamamı 17-65 yaşları arasındaydı; yaş ortalaması 46,52±11,85 yıl idi. 2020 yılında vakaların %3.3'ünde insan papilloma virüsü (HPV) tespit edilmiştir. Örnek yeterlilik oranı %99.3 olup %98.5'inde intraepitelyal lezyon ve malignite saptanmazken, en yüksek %11.8 oran ile inflamasyon gözlendi. Epitel hücre anomalilerinin (%1,5) %1,3'ünü skuamöz hücre anomalileri oluşturmaktaydı. Skuamöz hücre anomalileri arasında önemi belirsiz atipik skuamöz hücreler %0.86, düşük dereceli skuamöz intraepitelyal lezyonlar %0.22, şüpheli atipik skuamöz hücre %0.11, yüksek dereceli skuamöz intraepitelyal lezyonlar %0.08 ve skuamöz hücreli karsinom %0.01 idi. %. Atipik endoservikal hücreler (%0.01) en sık görülen glandüler hücre anomalisiydi ve endoservikal adenokarsinom (%0.003) en az görülen idi.
Sonuç: Servikal smear ve HPV DNA testleri servikal intraepitelyal lezyonların tanımlanmasında önemli bir role sahip olduğundan prekanseröz lezyonların invaziv kansere dönüşmesini önlemek için bölgesel ve ulusal tarama programları yaygın olarak kullanılmalıdır.

Anahtar Kelimeler

rahim ağzı kanseri, insan papilloma virüsü, tarama, vajinal yayma

Kaynakça

• 1. Findik S, Findik S, Abuoğlu S, Cihan FG, Ilter H, Iyisoy MS. Human papillomavirus (HPV) subtypes and their relationships with cervical smear results in cervical cancer screening: a community-based study from the central Anatolia region of Turkey. Int J Clin Exp Pathol. 2019;12:1391-8.
• 2. Gorkem U, Togrul C, Inal HA, Gungor T. Knowledge and attitudes of health care providers in university hospital related to Human Papilloma Virus and the vaccine. Türk Hijyen ve Deneysel Bioloji Dergisi. 2015;72:303-10. 3. Inal HA, Ozturk Inal Z, Alkan E. Successful Conservative Management of a Dislocated IUD. Case Rep Obstet Gynecol. 2015;2015:130528.
• 4. Inal ZO, Inal HA, Kucukosmanoglu I, Kucukkendirci H. Assessment of Endometrial Sampling and Histopathological Results: Analysis of 4,247 Cases. Eurasian J Med. 2017;49:44-7. 5. Inal ZO, Inal HA. Comparison of abdominal, vaginal, and laparoscopic hysterectomies in a tertiary care hospital in Turkey. Ir J Med Sci. 2018;187:485-91.
• 6. Centers for Disease Control and Prevention (CDC). National and state vaccination cover-age among adolescents aged 13-17 years--United States, 2012. MMWR Morb Mortal Wkly Rep 2013;62:685-93.
• 7. Castle PE, Stoler MH, Wright TC Jr, Sharma A, Wright TL, Behrens CM. Performance of carci¬nogenic human papillomavirus (HPV) testing and HPV16 or HPV18 genotyping for cervical cancer screening of women aged 25 years and older: a subanalysis of the ATHENA study. Lancet Oncol 2011;12:880-90.
• 8. Arbyn M, Bergeron C, Klinkhamer P, Martin-Hirsch P, Siebers AG, Bulten J. Liquid compared with conventional cervical cytology: a systematic review and meta-analysis. Obstet Gynecol 2008;111:167-77.
• 9. T.C. Sağlık Bakanlığı, Kanserle Savaş Dairesi Başkanlığı. Ulusal Kanser Kontrol Programı 2009 [online]. 10. Karabulut A, Alan T, Ali Ekiz M, İritaş A, Kesen Z, Yahşi S. Evaluation of cervical screening results in a population at normal risk. Int J Gynaecol Obstet. 2010;110:40-2.
• 11. Kurdoğlu Z, Kurdoğlu M, Gelir GK, Keremoğlu Ö. Van Kanser Erken Teşhis, Tarama ve Eğitim Merkezi’ne ait serviks ve meme kanserlerini tarama programı sonuçları. Van Tıp Dergisi. 2009;16:119-23.
• 12. Tuncer ZS, Başaran M, Sezgin Y, Firat P, Mocan Kuzey G. Clinical results of a split sample liquid-based cytology (ThinPrep) study of 4,322 patients in a Turkish institution. Eur J Gynaecol Oncol. 2005;26:646-8.
• 13. Ersöz Ş, Reis A, Baki N. Cervical screening programme in Trabzon country. Türk Jinekoloji ve Obstetrik Derneği Dergisi (TJOD Derg) 2010;7:35-9.
• 14. Tuncer R, Uygur D, Kış S, Erdinç S, Bebitoğlu İ, Tezer A, et al. Ankara Zübeyde Hanım Doğumevi 1999-2000 Yılları Pap Smear Sonuçları: 3013 Olgunun Analizi . Medical Network Klinik Bilimler ve Doktor. 2003;9:94 -96.
• 15. Kög İ, Turan T, Karabük E, Karayünlü B, Özgül N, Demir ÖF, et al. Cervical and Breast Cancer Secreening Programme Results of Etlik KETEM Group. TAF Prev Med Bull 2012;11:145-52.
• 16. Turkish Cervical Cancer And Cervical Cytology Research Group. Prevalence of cervical cytological abnormalities in Turkey. Int J Gynaecol Obstet. 2009;106:206-9.
• 17. Seven A, Kocak C, Yuksel KB, Kucur S, Gozukara I, Erbakirci NM. The evaluation of cervical pap-smear results of the patients who admitted to Obstetrics and Gynecology Clinic of Dumlupinar University Kutahya Evliya Celebi Training and Research Hospital. Turkish Journal of Clinics and Laboratory. 2015;7:1-4.
• 18. Malkawi SR, Abu Hazeem RM, Hajjat BM, Hajjiri FK. Evaluation of cervical smears at King Hussein Medical Centre, Jordan, over three and a half years. East Mediterr Health J 2004;10:676-9.
• 19. Vesco KK, Whitlock EP, Eder M, Burda BU, Senger CA, Lutz K. Risk factors and other epidemiologic considerations for cervical cancer screening: a narrative review for the U.S. Preventive Services Task Force. Ann Intern Med 2011;155:698-705.
• 20. zur Hausen H. Papillomaviruses causing can¬cer: evasion from host-cell control in early events in carcinogenesis. J Natl Cancer Inst 2000;92:690-8.
• 21. Sigurdsson K, Sigvaldason H. Longitudinal trends in cervical cytological lesions and the effect of risk factors. A 30-year overview. Acta Obstet Gynecol Scand 2006;85:350-8.
• 22. Acikgoz A, Ergor G. Cervical cancer risk levels in Turkey and compliance to the national cervi¬cal cancer screening standard. Asian Pac J Cancer Prev 2011;12:923-7.
• 23. Bruni L, Diaz M, Castellsague X, Ferrer E, Bosch FX, de Sanjose S. Cervical human papil¬lomavirus prevalence in 5 continents: meta-analysis of 1 million women with normal cyto¬logical findings. J Infect Dis 2010; 202:1789-99.
• 24. Demir ET, Ceyhan M, Simsek M, Gunduz T, Arlier S, Aytac R, et al. The prev¬alence of different HPV types in Turkish women with a normal Pap smear. J Med Virol 2012;84:1242-7.
• 25. Bayram A, Erkilic S, Balat O, Eksi F, Ugur MG, Ozturk E, et al. Prevalence and genotype distribution of human papillomavirus in non-neoplastic cervical tissue lesion: cervical ero¬sion. J Med Virol 2011;83:1997-2003.