Anormal PAP-smear ve/veya HPV Pozitifliği Olan Kadınların Kolposkopik Muayeneleri ve Servikal Histopatoloji Sonuçlarının Değerlendirilmesi: Amasya Örneği

Yıl 2020, Cilt: 4 Sayı: 3, 142 - 149, 31.12.2020

Banuhan Şahin , Esra Güner , Osman Fadıl Kara

Öz

Amaç: Kliniğimize anormal pap-smear ve/veya pozitif HPV (human papilloma virüs) sonuçları ile başvuran kadınlara yaptığımız kolposkopik incelemelerin ve aldığımız servikal biyopsilerin sonuçlarını analiz etmek.
Gereç ve yöntem: Ocak 2018 ve Ocak 2020 tarihleri arasında jinekoloji polikliniklerimize başvurmuş smear sonucu: atipik skuamoz hücreler (ASCUS), düşük dereceli servikal intraepitelyal lezyon (LGSIL), yüksek dereceli servikal intraepitelyal lezyon (HGSIL) ve atipik skuamoz hücreler-yüksek dereceli lezyonun ekarte edilemediği (ASC-H) olan ve/veya HPV testi:16, 18, ve diğer tipleri pozitif olan kadınların yapılmış kolposkopik muayene bulguları, punch biyopsi sayıları ve en nihai histopatolojik sonuçları retrospektif olarak incelendi. Bulguların karşılaştırılmasında Ki-kare testi kullanıldı.
Bulgular: Çalışmaya dahil edilen 214 hastanın yaş ortalaması 46.54 ± 10.765 idi. Pap-smear sonuçları sırasıyla; 71 (%33.2) hastanın ASCUS, 2 (%0.9) hastanın ASC-H, 23 (%10.7) hastanın LGSIL, 8 (%3.7) hastanın HGSIL ve 110 (%51.4) hastanın normal veya inflamasyon şeklinde idi. HPV 16 pozitifliği 58 (%27.1), HPV 18 pozitifliği 12 (%5.6), diğer yüksek risk tip HPV pozitifliği 84 (%39.3), diğer tip HPV pozitifliği ise 53 (%24.8) kadında mevcuttu. Kolposkopi bulgusu olarak 60 (%28) kadında lökoplaki, 40 (%18.7) kadında beneklenme, 26 (%12.1) kadında mozaik görünüm ve 24 (%11.2) kadında atipik damarlanma mevcuttu. 53 (%24.8) kadından tek punch biyopsi alınmışken, 161 (%75.2) kadından çoklu punch biyopsi alınmıştı. Histopatolojik sonuçlar 45 (%21) kadında LGSIL, 15 (%7) kadında HGSIL ve 1 (%0.5) kadında karsinom olarak raporlanmıştı. Kolposkopik muayene bulguları ile punch biyopsi alma sayısı arasında ilişki izlenmedi (p=0.655). Ancak, punch biyopsi sayısı arttıkça LGSIL, HGSIL ve karsinom olasılığı da artmaktaydı (p=0.006).
Sonuç: Kolposkopik muayene bulgularının özelliklerine göre punch biyopsi alma sayısı değişmezken, biyopsi sayısı arttıkça servikal premalign ve malign lezyon yakalama olasılığı artmaktadır. Kolposkopik incelemede lezyonun görülemediği durumda servikal punch biyopsi sayısının artırılması gerektiği kanaatindeyiz.

Anahtar Kelimeler

HPV, kolposkopi, pap-smear, punch biyopsi, serviks kanseri

Destekleyen Kurum

Amasya Üniversitesi Etik Kurulu

Proje Numarası

2019/8-45

Teşekkür

Sayın editöre değerlendirme için teşekkür ederiz.

The Evaluation of Colposcopic Examinations and Cervical Histopathology Results of Women With Abnormal PAP-smear and/or HPV Positivity: A Sample From Amasya

Öz

Aim: To analyse the cervical biopsies and colopscopic examinations made of women who presented at our clinic with abnormal pap-smear and/or human papilloma virus (HPV) positivity.
Material and Method: A retrospective examination was made of the colopscopy findings, number of punch biopsies and final histo-pathological results of patients who presented at the gynaecology polyclinic between January 2018 and January 2020 with a smear result showing atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesions (LGSIL), high-grade squamous intraepithelial lesions (HGSIL), and atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H), and/or HPV test was 16, 18 and other types of positivity. The Chi-square test was applied in the comparisons of the findings.
Results: Evaluation was made of 214 patients with a mean age of 46.54±10.76 years. The pap-smear results were recorded as ASCUS in 71 (33.2%) patients, ASC-H in 2 (0.9%), LGSIL in 23 (10.7%), HGSIL in 8 (3.7%) and normal or showing inflammation in 110 (51.4%). HPV 16 positivity was determined in 58 (27.1%) patients, HPV 18 positivity in 12 (5.6%), other high-risk type HPV positivity in 84 (39.3%) and other type HPV positivity in 53 (24.8%). The colposcopy findings were recorded as leukoplakia in 60 (28%) patients, a punctuation appearance in 40 (18.7%), mosaic appearance in 26 (12.1%), and atypical vascularisation in 24(11.2%). A single punch biopsy was taken from 53 (24.8%) patients, and multiple biopsies were taken from 161 (75.2%). The histo-pathological results were reported as LGSIL in 45 (21%) patients, HGSIL in 15 (7%) and carcinoma in 1 (0.5%). No correlation was determined between the colopscopic examination findings and the number of punch biopsies (p=0.655). As the number of punch biopsies increased, so the probability of LGSIL, HGSIL, and carcinoma increased (p=0.006).
Conclusion: While the colposcopy examination findings did not affect the number of punch biopsies, it was seen that as the number of punch biopsies increased so did the probability of capturing cervical premalignant and malignant lesions. When no lesion is seen in the colposcopy examination, the number of cervical punch biopsies should be increased.

Anahtar Kelimeler

cervical cancer, colposcopy, HPV, pap-smear, punch biopsy

Proje Numarası

2019/8-45

Kaynakça

• Referans 1. Forman D, de Martel C, Lacey CJ, Soerjomataram I, Lortet-Tieulent J, Bruni L, et al. Global burden of human papillomavirus and related diseases. Vaccine 2012; 30: 12-23.
• Referans 2. Eroğlu C, Keşli R, Eryılmaz MA, Ünlü Y, Gönenç O, Çelik Ç. Serviks kanseri için riski olan kadınlarda HPV tiplendirmesi ve HPV sıklığının risk faktörleri ve servikal smearle ilişkisi. Nobel Med 2011; 7: 72-77.
• Referans 3. Aref MA, Freeman WT. Cervical cancer prevention and screening: the role of human papillomavirus testing. The Obstet Gynaecol 2016; 18: 251-263.
• Referans 4. De Sanjose S, Quint WG, Alemany L, Geraets DT, Klaustermeier JE, Lloveras B, et al. Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross sectional worldwide study. Lancet Oncol 2010; 11: 1048-1056.
• Referans 5. Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam S, Cain J, et al. American cancer society, american society for colposcopy and cervical pathology, and american society for clinical pathology screening guidelines for the prevention and early detection of cervical cancer. Am J Clin Pathol 2012; 137: 516-542.
• Referans 6. Ronco G, Dillner J, Elfstrom KM, Tunesi S, Snijders PJ, Arybn M, et al. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of 4 European randomised controlled trials. Lancet 2014; 383: 524-532.
• Referans 7. Huh WK, Ault KA, Chelmow D, Davey DD, Goulart RA, Garcia FA, et al. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. Gynecol Oncol 2015; 136: 178-182.
• Referans 8. Frank JE. The Colposcopic Examination. J. Midwifery Womens Health 2008; 53: 447-452.
• Referans 9. Şahin B, Karli P, Kara OF. Could We Reduce Unnecessary Colposcopic Examinations? GMJ 2020; 31: 383-386.
• Referans 10. Kyrgiou M, Tsoumpou I, Vrekoussis T. The up-to-date evidence on colposcopy practice and treatment of cervical intraepithelial neoplasia: The cochrane colposcopy &cervical cytopathology collaborative group (C5 group) approach. Cancer Treat. Rev 2006; 32: 516-523.
• Referans 11. Jemal A, Ward E, Thun M. Declining death rates reflect progress against cancer. PLoS One 2010; 5: e9584.
• Referans 12. Wright TC Jr, Stoler MH, Behrens CM, Apple R, Derion T, Wright TL. The ATHENA human papillomavirus study: design, methods, and baseline results. Am J Obstet Gynecol 2012; 206: 46.e1-46.e11.
• Referans 13. Catarino R, Petignat P, Dongui G, Vassilakos P. Cervical cancer screening in developing countries at a crossroad: emerging technologies and policy choices. World J Clin Oncol 2015; 6: 281-290.
• Referans 14. Lee S, Kim JW, Hong JH, Song JY, Lee JK, Kim IS, et al. Clinical significance of HPV DNA cotesting in Korean women with ASCUS or ASC-H. Diagn Cytopathol 2014; 42: 1058-1062.
• Referans 15. Tracht J, Wrenn A, Eltoum IE. Primary HPV testing verification: a retrospective ad-hoc analysis of screening algorithms on women doubly tested for cytology and HPV. Diagn Cytopathol 2017; 45: 580-586.
• Referans 16. US Food and Drug Administration (FDA). FDA approves first human papillomavirus test for primary cervical cancer screening. Silver Spring, MD: FDA; 2014. Available at: www.eve-medical. com/fda-approves-first-human-papillomavirus-test-for-primary-cervical-cancer-screening/. Accessed January 1, 2018.
• Referans 17. Gultekin M, Zayifoglu Karaca M, Kucukyildiz I, Dundar S, Boztas G, Semra Turan H, et al. Initial results of population based cervical cancer screening program using HPV testing in one million Turkish women. Int J Cancer 2018; 142(9): 1952-1958.
• Referans 18. Gultekin M, Karaca MZ, Kucukyildiz I, Dundar S, Keskinkilic B, Turkyilmaz M. Mega Hpv laboratories for cervical cancer control: Challenges and recommendations from a case study of Turkey. Papillomavirus Res 2019; 7: 118-122.