Eş Zamanlı HPV Testi ve Smear Örneklerinde HPV Pozitifliğinin Sitomorfolojik Yansımaları

Öz

Amaç: Serviks kanseri, dünya genelinde kadınları etkileyen en yaygın maligniteler arasında yer almakta olup, tüm kadın kanserlerinin yaklaşık %12’sini oluşturmaktadır. Yüksek riskli insan papillomavirüsü (hrHPV) bu hastalığın başlıca etiyolojik etkenidir. Sitolojiye dayalı tarama yöntemleri erken tanıda temel bir rol oynamaya devam etmekle birlikte, moleküler HPV testleri, özellikle yüksek dereceli lezyonların ve asemptomatik enfeksiyonların saptanmasında duyarlılığı artırmaktadır. Bu çalışmanın amacı, likit bazlı papanicolaou smear örneklerinde hrHPV pozitifliği ile ilişkili sitomorfolojik özellikleri incelemek ve tek bir bölgesel popülasyon içinde yaş gruplarına göre hrHPV alt tiplerinin dağılımını değerlendirmektir.

Materyal ve metod: Bu retrospektif çalışmaya, 2015-2016 yılları arasında Dicle Üniversitesi Tıp Fakültesi Patoloji Anabilim Dalı’nda eş zamanlı hrHPV DNA testi ve sıvı bazlı sitoloji yapılan 1.500 hasta dahil edildi. hrHPV testi tam otomatik Roche Cobas X4800 sistemi ile yapıldı. Sitolojik değerlendirme 2014 Bethesda sistemine göre gerçekleştirildi. Sitomorfolojik bulgular ile hrHPV alt tipleri arasındaki ilişkiler SPSS v18.0 programında, p<0,05 anlamlılık düzeyi ile analiz edildi.

Bulgular: Bin beş yüz olgunun 141’inde (%9,4) hrHPV pozitifliği saptandı. Bu olguların 26’sında (%18) HPV 16, 14’ünde (%10) HPV 18 ve 101’inde (%72) diğer hrHPV alt tipleri tespit edildi. ASC-US, LSIL ve HSIL gruplarında HPV 18 pozitifliği gözlenmedi. Perinükleer halo, multinükleasyon ve parakeratoz gibi sitomorfolojik bulgular hrHPV pozitif olgularda sık görüldü. Normal sitolojiye sahip 1.418 olgunun 138’inde (%9,7) hrHPV pozitifliği saptandı ve bu durum latent/subklinik enfeksiyona işaret etti.

Sonuç: Moleküler hrHPV testi ile sitomorfolojik değerlendirmenin birlikte kullanılması, serviks kanseri taramalarında tanısal verimi artırmaktadır. hrHPV ile ilişkili belirli sitolojik bulguların tanınması, özellikle moleküler testlere erişimi olmayan durumlarda, risk sınıflamasına ve klinik yönetime katkı sağlayabilir. Bu ilişkilerin doğrulanması için daha geniş, çok merkezli çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Yüksek riskli HPV
• servikal sitoloji
• Bethesda sistemi
• servikal kanser taraması
• HPV subtipleri

Cytomorphological Reflections of HPV Positivity in Concurrent HPV Testing and Smear Specimens

Öz

Background: Cervical cancer is one of the most common malignancies affecting women worldwide, accounting for approximately 12% of all cancers in women. High-risk human papillomavirus (hrHPV) is the principal etiological agent. Although cytology-based screening remains a cornerstone of early detection, molecular HPV testing enhances sensitivity, particularly for the detection of high-grade lesions and asymptomatic infections. The aim of this study was to investigate cytomorphological features associated with hrHPV positivity in liquid-based papanicolaou smear samples and to evaluate the distribution of hrHPV subtypes according to age groups within a single regional population.

Materials and Methods: This retrospective study included 1,500 patients who underwent simultaneous hrHPV DNA testing and liquid-based cytology at the Department of Pathology, Dicle University Faculty of Medicine between 2015 and 2016. hrHPV testing was performed using a fully automated Roche Cobas X4800 system. Cytological evaluations were conducted in accordance with the 2014 Bethesda System. Associations between cytomorphological findings and hrHPV subtypes were analyzed statistically using SPSS v18.0, with p-values < 0.05 considered significant.

Results: hrHPV positivity was detected in 141 (9.4%) of the 1,500 cases. Of these, HPV 16 was identified in 26 cases (18%), HPV 18 in 14 cases (10%), and other hrHPV subtypes in 101 cases (72%). No HPV 18 positivity was observed among the ASC-US, LSIL, and HSIL groups. Cytomorphological features, such as perinuclear halo, multinucleation, and parakeratosis, were frequently detected in hrHPV-positive cases. Notably, 138 of 1,418 cases with normal cytology exhibited hrHPV positivity (9.7%), indicating latent or subclinical infection.

Conclusions: The combination of molecular hrHPV testing and cytomorphological evaluation enhanced the diagnostic yield of cervical cancer screening. Recognizing the specific cytological features associated with hrHPV can assist in risk stratification and guide clinical management, particularly in cases lacking access to molecular testing. Larger multicenter studies are warranted to validate these associations further.

Anahtar Kelimeler

• High-risk HPV
• cervical cytology
• Bethesda system
• cervical cancer screening
• HPV subtypes

Kaynakça

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