HPV DNA pozitif olguların servikal smear ile korelasyon sonuçları her zaman uyumlu mudur?

Abstract

Amaç: Serviks kanseri, ölüme neden olan ve meme kanserinden sonra kadınlarda en sık görülen ikinci kanserdir. Ancak tarama testleri ile erken teşhis edilerek önlenebilen bir genital kanser türüdür. Serviks kanserlerinin çoğu (%99,7) Human Papilloma Virus (HPV) ile ilişkili olup günümüzde de servikal kanser gelişimi için HPV’nin mutlaka olması gerektiği bilinmektedir. Nitekim hastaların %70’inde HPV-16 ve HPV-18’in pozitif olduğu tespit edilmiştir. Bu çalışmada servikal kanser-HPV ilişkisi, displazi ve kanser gelişme oranları ile ilgili veriler retrospektif olarak araştırılmıştır. HPV pozitif tüm olgularda hastaların smear sonuçları ile HPV sonuçlarının uyumlu olup olmadığı kontrol edilerek sonuçların analiz edilmesi ve kullanılması planlanmıştır. Materyal ve Metod: Çalışmaya Temmuz 2020 ve Mart 2022 tarihleri arasında jinekolog tarafından muayeneleri yapılmış ve muayene sonunda Pap smear örneği alınmış 1050 olgu dahil edilmiştir. Tüm olguların Pap smear testleri patolog tarafından 2014 Bethesda sistemi kullanılarak yeniden değerlendirilmiştir. Çalışmada yer alan hastalara dış merkezde uygulanan yüksek risk HPV (HR HPV) DNA (HPV tipleri 16,18,31,33,35,39,45,51,52,56,58,59,66,68) test sonuçları tekrar gözden geçirilmiştir. Pap testte düşük dereceli skuamöz intraepitelyal lezyon (LSIL), yüksek dereceli skuamöz intraepitelyal lezyon (HSIL) ve servikal kanser bulguları saptanan ve HPV DNA analizi yapılan hastaların sonuçları ve dosya bilgilerinde yer alan diğer veriler yeniden değerlendirilmiştir. İstatistiksel analiz için Ki-kare testi kullanılmıştır ve p<0.05 değerleri anlamlı kabul edilmiştir. Bulgular: 1050 hastanın 139’unda LSIL, 170’inde HSIL ve 112’sinde servikal kanser olduğu görülmüştür. En fazla LSIL, HSIL ve kanser görülme oranı 30-39 yaş grubunda izlenirken, 50-59 yaş grubunda bu hastalıkların oranının diğer yaş gruplara göre daha düşük olduğu izlenmiştir. Ayrıca SIL ve kanser görülen tüm hastalar sigara kullanmaktadır.1050 hastanın 240’ında HR HPV DNA testi pozitiftir. Smear sonuçlarına göre LSIL tanısı alan 56 hasta ve HSIL tanısı alan 89 hastada HR HPV DNA testi pozitiftir. Servikal kanser görülen 112 hastanın 74’ünde HR HPV DNA pozitifliği rapor edilmiştir. Smear sonuçları normal olan 21 hastanın HR HPV testlerinde pozitiflik bulunmuştur. Bu hastaların 17’si 30-39 yaş grubunda 4‘ü 40-49 yaş grubundadır. Sonuçlar: Bizim çalışmamızda kanser görülen 112 hastanın hepsinde HR HPV DNA’nın pozitif olmaması ve 21 HR HPV DNA pozitif hastanın smear sonuçlarının normal olması servikal kanserde smear ve HPV DNA sonuçlarının her zaman uyumlu olmayacağı yönündeki çalışmalar için bir örnek teşkil etmektedir.

Keywords

• serviks
• kanser
• HPV
• tarama

Are the correlation results of HPV positive cases with cervical smear always consistent?

Abstract

Aim: Cervical cancer is a type of genital cancer which come second after breast cancer in women and may cause death. However, it can be prevented with screening tests by ensuring early diagnosis. Most of cervical cancers (99.7%) are associated with Human Papilloma Virus (HPV) and it is known that HPV must be present for the generation of cervical cancer. Thus, 70% of the patients have been found to be positive for HPV-16 and HPV-18. Both the association with cervical cancer and HPV and data related to development of cancer and dysplasia was researched retrospectively in this study. It was aimed to analyze and use the results by examine if the smear results of the patients and the HPV results are compatible in all HPV positive cases. Material and Method: 1050 patients who were examined by gynecologist and taken Pap smear test at the end of the examination during July 2020 and March 2022, were included in our study. In all cases the Pap test was re-evaluated by the same pathologist using the 2014 Bethesda System. High-risk HPV (HR HPV) DNA (HPV types 16,18,31,33,35,39,45,51,52,56,58,59,66,68) tests results, applied to the patients at an external center, were reviewed. Results of patients diagnosed as LSIL, HSIL and cervical cancer by Pap smear test were evaluated again beside HPV DNA analyses and their clinical information. Chi-square test was used for statistical analysis. p<0.05 values were considered statistically significant. Results: Of 1050 patients, 139 had LSIL, 170 had HSIL, and 112 had cervical cancer. The highest incidence of LSIL, HSIL and cancer was observed in the 30-39 age group, while the rate of these diseases was lower in the 50-59 age group compared to other groups. In addition, all patients with SIL and cervical cancer had smoking history. HR HPV DNA test was positive in 240 of 1050 patients. 56 patients diagnosed as LSIL and 89 patients diagnosed as HSIL by Pap smear had positive HR HPV DNA test results. HR HPV DNA positivity was reported in 74 of 112 patients with cervical cancer. In 21 patients who had normal smear test were detected HR HPV DNA positivity. 17 of these patients were in the 30-39 age group and 4 of them were in the 40-49 age group. Conclusions: Because of all 112 patients with cancer were not HR HPV positive and the smear results of 21 HR HPV positive patients were normal, our study serves an example for studies to show that the results of smear and HPV DNA in cervical cancer are not always compatible.

Keywords

• Cervix
• cancer
• HPV
• screening

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