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

Yıl 2023, Cilt: 4 Sayı: 2, 158 - 162, 27.03.2023

Sema Zergeroğlu , Zehra Sema Özkan , Arzu Hazal Aydın

https://doi.org/10.47582/jompac.1258024

Öz

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.

Anahtar Kelimeler

serviks, kanser, HPV, tarama

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

Öz

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.

Anahtar Kelimeler

Cervix, cancer, HPV, screening

Kaynakça

• Kurman RJ. Carcinoma and other tumors of the cervix. 4th Edition New York. Springer –Verlag 1994.
• Koss LG, The Papanicolau test for cervical cancer detection. A tri­umph and a tragedy. JAMA 1989; 261: 737-43.
• Klinkhamer PJ, Wooijs GP, De Han AF. Intraobserver and interob­server variability in the histopathological diagnosis of epithelial ab­normalities in servical smears. Acta Cytol 1988; 32: 794-9.
• Östor AG. Natural history of cervical intraepithelial neoplasia a cri­tical review. Int J Gyneacol Pathol 1993; 12(2): 185-92.
• Richart RM, A modified terminology for cervical intrepithelial ne­oplasia. Obstet Gynecol 1990; 75: 131-3.
• Scheungraber C, Kleekamp N, SchneiderA. Management of low-grade Squamous intrepithelial lesions of the uterine cervix. Br J Cancer 2004; 90: 975-8.
• Robertson JH, Woodent B, Elliot H. Cytological changes preceding cervical cancer. J Clin Pathol.1994; 47: 278-9.
• Solomon D, Davey D, Kurman R, et al. The 2001 Bet­hesda system. terminology for reporting results of cervical cytology. JAMA 2002; 287: 2114-9.
• Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019; 69: 7‐34
• Saslow D, Runowicz CD, Solomon D, et al. American Cancer Society guideline for the early de­tection of cervical neoplasia and cancer CA Cancer J Clin 2002 ; 52 : 342-62.
• Hare AA, Duncan AR, Sharp AJ. Cytology suggestive of glandular neoplasia : outcomes and suggested management . Cytopathology 2003; 14: 12-8.
• Clavel C, Cucherousset J, Lorenzato M, et al. Negative human papilloma virüs testing in normal smears selects a population at low risk for developing high Grade cervical lesions. Br J Cancer 2004; 90: 1803-8.
• Chivukula M, Shidam BV, ASC-H in Pap test-definitive categoriza­tion of cytomorphological spectrum. Cyto J 2006; 3(14): 19.
• Zhang Q, Xiong Y, Ye J, Zhang L, Li L. Influence of clinico patho­logical caracteristics and comprehensive treatment models on the prognosis of smallcell carcinoma of the cervix: A systematic review and meta-analysis. PLoS One 2018; 13(4): e0192784.
• Hosono S, Terasawa T, Katayama T, Sasaki S, Hoshi K, Hamashima C. Frequency of unsatisfactory cervical cytology smears in cancer screening of Japanese women: a systematic review and meta-analy­sis. Cancer Sci 2018; 109(4): 934-43.
• Ozturk M, Umudum H, Alanbay I, et al. Risk of HSIL(CIN2-3) on colposkopic biopsy is minimal in postmenopausal women with LSIL on cytology and negative HRHPV test. Diagn Cytopathol 2017; 44: 969-74.
• Perkins RB, Cain JM, Feldman S. Using risk stratificationto reduce medical errors in cervicocancer prevention. JAMA Intern Med 2017; 177: 1411–2.
• Zergeroglu S, Gungor T, Yalcın H. Should Post-menopausal women be screened only with HPV test in cervical cancer. J Clin Exp Oncol 2017; 7: 1
• Katki HA, Kinney WK, Fetterman B, et al. Cervical cancer risk for women under going concurrent testing for human papilloma virüs and cervical cytology: a population-based study in routine clinical practice.Lancet Oncoll 2011; 12: 663-72.
• Sharif YH. Clinical correlation of cervical cancer screening using Pap smear test. J Popul Ther Clin Pharmacol 2022; 29(1): 1-8.
• Song T, Seong SJ, Lee SK, et al. Screening capacity and cost-effectiveness of the human papillomavirus test versus cervicography as an adjunctive test to Pap cytology to detect high-grade cervical dysplasia. Eur J Obstet Gynecol Reprod Biol 2019; 234: 112-6.
• Song T, Seong SJ, Lee SK, et al. Searching for an ideal cervical cancer screening model to reduce false-negative errors in a country with high prevalence of cervical cancer J Obstet Gynaecol 2020; 40(2): 240-6.