Servikal kanser taramasında saptanan önemi belirlenemeyen atipik skuamoz hücrelerin klinik değerlendirmesi: Eskişehir deneyimi

Yıl 2021, Cilt: 14 Sayı: 4, 862 - 868, 01.10.2021

Hulusi Göktuğ Gürer , Ceren Yıldız Eren , Özlem Özgür Gürsoy , Ramazan Bayırlı

https://doi.org/10.31362/patd.856068

Öz

Özet

Amaç: Çalışmamızın amacı çeşitli şikayetlerle başvuran, daha önce servikal lezyon tanısı almamış, smear sonucu önemi belirlenemeyen atipik squamoz hücreler (ASCUS) olup, co-test yapılmış olguların kolposkopik bulguları ile histopatolojik sonuçlarını karşılaştırıp, ASCUS tanısının klinikteki önemini ortaya koymak.
Gereç ve Yöntem: Retrospektif analize Ocak 2011 - Mayıs 2020 tarihleri arasında Pap smear test sonucu ASCUS çıkan,  24-74 yaş arasında, kolposkopik biyopsi yapılıp, HPV DNA genotip tayini olan 177 hasta dahil edildi. Olguların kolposkopik bulguları Reid Kolposkopi İndeksine (RCI) göre sınıflandırıp, histopatoloji sonuçları ile karşılaştırıldı.
Bulgular: İncelenen 177 hastanın yaş ortalaması 37,1±1,41 (24-74), parite 2,8±1.07 (0-11) ve sigara kullanımı ortalama 6 adet/gün (0- 40 adet/gün) olarak saptandı. Olguların 148'i (%83,6) premenopoz, 29'u (%16,3) postmenopoz dönemde idi. Kolposkopi eşliğinde biyopsi yapılan 68 olguya (%38,4) kronik servisit teşhisi konmuş olup, geriye kalan 108 (% 61,0) hastada servikal intraepitelyal lezyonlar (CIN) [85 (%48) CIN 1, 16 (%9) CIN 2, 7 (%3,9) CIN 3] ve 1(%0,5) olguda da servikal karsinom (CX CA) tespit edildi. Hastaların HPV DNA tiplendirme ve RCI ile biyopsi sonuçları karşılaştırıldığında Pearson Exact (Kesin) Ki-Kare testi ile gruplar arasında istatiksel olarak farklılık anlamlı bulundu (p<0.001).
Sonuç: Bulgularımız ASCUS saptanan olgularda, HPV DNA testi negatif olsa da kolposkopik inceleme endikasyonu olduğunu göstermektedir. Bu nedenle çalışmamız tek başına HR-HPV taramasının smear testinin yerini alamayacağını, sitolojik incelemenin de yapıldığı co-testin tanı ve tedavi amaçlı daha uygun olduğunu göstermektedir.

Anahtar Kelimeler

ASCUS, kolposkopi, HPV, Reid İndeksi

Teşekkür

Teşekkür: Patolog Uzm. Dr. Rezzan Köksal ve patoloji teknisyeni Gözde Şafak'a titiz çalışmalarından ve hastaların dosya taramasındaki desteklerinden dolayı teşekkür ederiz.

Clinical evaluation of atypical squamous cells of undetermined significance diagnosed by cervical cytological screening: Eskisehir experience

Öz

Purpose : Aim of our study is to compare the colposcopic findings with the histopathologic results of atypical squamous cells of undetermined significance (ASCUS) diagnosed during cervical cytological screening in patients applied with various complaints and evaluated with co-test so as to to determine the clinical value of it.
Materials and Methods: In this retrospective analysis 177 patients who attended between January 2011 and may 2020, aged between 24-74 years, with the result of ASCUS in their Pap smear tests, were enrolled. Colposcopic findings of cases were classified according to Reid Colposcopic Index (RCI) and compared with the histopathologic results.
Results: 177 patients were analyzed and the mean age of them was 37,1±1,41 (24-74), parity 2,8±1.07 (0-11) and mean smoking was found to be 6 cigarettes/day (0-40 cigarettes/day). 148 (%83,6) of cases were in premenapouse, 29 (%16,3) of them were in postmenapousal period. 68 (%38,4) patients were diagnosed as chronic cervicitis by colposcopy assisted cervical biyopsy, rest 108 (%61,0) were determined as cervical intraepithelial lesions (CIN) [85 (%48) CIN 1, 16 (%9) CIN 2, 7 (%3,9) CIN 3] and 1(%0,5) patient was found to be cervical carcinoma (CX CA). Comparison between HPV DNA types and RCI with biopsy results was analyzed with Pearson Exact Chi-square test and found to be statistically significant between groups (p<0.001).
Conclusion: Our results put forth that colposcopic evaluation is needed in patients with cytologic ASCUS results even if HR-HPV DNA test is negative. That's why Pap smear test cannot be replaced by screening only with HR-HPV DNA, co-test requirement showed to be more suitable because of cytologic evaluation involvement.

Anahtar Kelimeler

ASCUS, colposcopy, HPV, Reid Index

Kaynakça

• 1. Zekioglu O, Ozdemir N. Serviks kanserleri patolojisi [Cervical carcinoma]. Turkiye Klinikleri J Med Oncol Special Topics 2011;4:14-19.
• 2. Ortac F, Taskın S. Serviksin malign hastalıkları [Malign disorders of cervix]. Turkiye Klinikleri J Surg Med Sci 2007;3:55-58.
• 3. Cancer, I.A.f.R.o., Globocan 2018: estimated cancer incidence, mortality and prevalence worldwide in 2018. http://gco.iarc.fr/today/explore. Erişim tarihi 14 Aralık 2020
• 4. Qiao YL. Perspective of cervical cancer prevention and control in developing countries and areas. Chin J Cancer 2010;29:1-3.
• 5. Ozan H. Servikal karsinogeneziste HPV'nin rolü [The role of HPV in cervical carcinogenesis]. Turkiye Klinikleri J Gynecol Obst-Special Topics 2009;2:9-12.
• 6. Kitchener HC, Castle PE, Cox JT. Achievements and limitations of cervical cytology screening. Vaccine 2006;24:63-70. https://doi.org/10.1016/j.vaccine.2006.05.113
• 7. ACOG practice bulletin no 99: Management of abnormal cervical cytology and histology. Obstetrics and Gynecology 2008;112:1419–1444. doi:10.1097/AOG.0b013e318192497c.
• 8. Türkiye Kanser Kontrol Programı. T.C. Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu Kanser Daire Başkanlığı. https://hsgm.saglik.gov.tr/depo/birimler/kanserdb/yayinlar/raporla r/Ulusal_Kanser_Kontrol_Plani_201 3_2018.pdf Erişim Tarihi:14 Aralık 2020.
• 9. Huh WK, Ault KA, Chelmow D, et al. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. Gynecol Oncol 2015;136:178-182. https://doi.org/10.1016/j.ygyno.2014.12.022
• 10. Burghardt E, Histopathologic basis of colposcopy. In: Colposcopy Cervical Pathology Textbook and Atlas, 4th ed. New York, NY: Georg Thieme Verlag, 2015;24-56.
• 11. Saslow D, Solomon D, Lawson HW, 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. American Journal of Clinical Pathology 2012;137:516-542. https://doi.org/10.1309/AJCPTGD94EVRSJCG
• 12. Mitchell MF, Schottenfeld D, Tortolero Luna G, Cantor SB, Richards Kortum R. Colposcopy for the diagnosis of squamous intraepithelial lesions: a meta-analysis. Obstet Gynecol 1998;91:626-631. https://doi.org/10.1016/S0029-7844(98)00006-4
• 13. Cantor SB, Cárdenas Turanzas M, Cox DD, et al. Accurary of colposcopy in the diagnostic setting compared with the screening setting Obstetrics & Gynecology 2008;111:7-14. doi:10.1097/01.AOG.0000295870.67752.b4
• 14. Auger M, Charbonneau M, Arseneau J. Atypical squamous cells of undetermined significance. a cytohistologic study of 52 cases. Acto Cytol 1997;41:1671-1675. doi: 10.1159/000333166
• 15. ALTS Group. A randomized trial on the management of lowgrade squamous intraepithelial lesion cytology interpretations. Am J Obstet Gynecol 2003;188:1393-1400. https://doi.org/10.1067/mob.[phone]
• 16.Demir ET, Ceyhan M, Simsek M, et al. The prevalence of different HPV types in Turkish women with a normal pap smear. J Med Virol 2012;84:1242-1247. https://doi.org/10.1002/jmv.23333 17.Castle PE, Wacholder S, Lorincz AT, et al. A prospective study of high-grade cervical neoplasia risk among human papillomavirus-infected women. J Natl Cancer Inst 2002;94:1406-1414. https://doi.org/10.1093/jnci/94.18.1406
• 18. Sarian LO, Hammes LS, Longatto Filho A, et al. Increased risk of oncogenic human papillomavirus infections and incident high-grade cervical intraepithelial neoplasia among smokers: experience from the Latin American screening study. Sex Transm Dis 2009:36;241-248. doi: 10.1097/OLQ.0b013e3181935a7d
• 19. Rijkaart DC, Berkhof J, Rozendaal L, et al. Human papillomavirus testing for the detection ofhigh-grade cervical intraepithelial neoplasia and cancer: final results of the POBASCAM randomised controlled trial. Lancet Oncol 2012;13:78-88. https://doi.org/10.1016/S1470-2045(11)70296-0
• 20. Perkins RB, Guido RS, Castle PE, et al. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis 2020;24:102-131. doi: 10.1097/LGT.0000000000000525