COMPARISON OF CONVENTIONAL AND LIQUID BASED SMEAR TECHNIQUES IN HUMAN PAPİLLOMA VIRUS POSITIVE WOMEN

Öz

Aim: It was aimed to compare conventional (CS) and liquid-based smear (LBS) techniques in women cathegorized according to Human Papilloma Virus (HPV) test results. Material and methods: 140 participant women admitted to Hitit University Hospital was included into this prospective cross-sectional study. According to HPV test results, the participants were divided into two groups; 1) HPV-negative (n=51) and 2) HPV-positive (n=89) groups.The specimens collected by CS and LBS techniques were reported according to Bethesta 2001 system; 1- Normal, 2- Atypical squamous cells of undetermined significance (ASC-US), 3- Atypical squamous cells- cannot exclude HSIL (ASC-H), 4- Low-grade squamous intraepithelial lesion (L-SIL), 5- High-grade squamous intraepithelial lesion (H-SIL), 6- Atypical Glandular Cells not otherwise specified (AGC-NOS) and 7- Inadequate specimen. Results: HPV-positive women were living at rural area (p=0.005), had lower economical level (p=0.010) and lower educational level (p=0.002). Both groups were statistically similar at the aspects of smoking, oral contraceptives, performing servical smear, medical history of genital infections (p=0.315, p=0.498, p=0.329, p=0.086 and p=0.773). Past genital warts were more frequent in HPV-positive group (p<0.001). L-SIL was more frequently reported in LBS technique (p<0.001). Other cytologically results were found to be similar in HPV groups (p>0.05, for all). The compatibility of the same results in both groups was not statistically different ((p=0.099). Conclusion: In our study, LBS technique has an advantage for detecting L-SIL, and it is demonstrated that there is no difference for cytological diagnosis. Furthermore, CS technique may be a preferable option to LBS technique due to increased costs. 

Anahtar Kelimeler

• Conventional,liquid based,smear,HPV,cytology

HUMAN PAPİLLOMA VİRÜS POZİTİF KADINLARDA KONVANSİYONEL VE SIVI BAZLI SMEAR TEKNİKLERİNİN KARŞILAŞTIRMASI

Öz

Amaç: Human Papilloma Virus (HPV) test sonuçlarına göre kategorize edilmiş kadınlarda konvansiyonel smear (KS) ve sıvı bazlı smear (SBS) tekniklerinin karşılaştırılması amaçlanmıştır. Materyal ve Metodlar: Bu prospektif kesitsel çalışmaya Hitit Üniversitesi Hastanesi başvuran 140 kadın dahil edildi. HPV test sonuçlarına göre katılımcılar ikiye ayrıldı: 1)HPV-negatif (n=51) ve 2)HPV-pozitif (n=89). KS ve SBS tekniklerine göre alınan örnekler Bethesta 2001sistemine göre şu şekilde yorumlandı. 1- Normal, 2- Önemi belirsiz atipik skuamöz hücre (ASC-US), 3- Yüksek dereceli skuamöz intraepitelyal lezyonun ekarte edilemediği atipik skuamöz hücreler (ASC-H), 4- Düşük dereceli skuamöz intraepitelyal lezyon (L-SIL), 5- Yüksek dereceli skuamöz intraepitelyal lezyon (H-SIL), 6- Sınıflandırılamayan atipik glandüler hücreler (AGC-NOS) ve 7- Yetersiz materyal. Bulgular: HPV pozitif katılımcıların daha çok kırsal bölgede yaşadığı (p=0.005), daha çok kötü ekonomik düzeyine (p=0.010) ve daha dü- şük eğitim düzeyine sahip oldukları (p=0.002) belirlendi. Her iki grup sigara içme, oral kontraseptif kullanımı, smear testi yaptırma durumu, genital enfeksiyon öyküsü istatistiksel olarak benzer idiler (p=0.315, p=0.498, p=0.329, p=0.086 ve p=0.773). Ancak geçirilmiş genital siğil öyküsü HPV pozitif grupta daha sık idi (p<0.000). L-SIL tanısı istatistiksel anlamlılıkla SBS tekniğinde daha sık rapor edilmişti (p<0.001). Diğer tüm tanıların sıklığının ise HPV pozitif ve negatif gruplarda istatistiksel anlamda benzer olduğu saptandı (p>0.05). Her iki smear tekniğinde rapor edilen aynı sitolojik sonuçların çıkma uyumluluğu açısından anlamlı bir fark gözlenmedi (p=0.099). Sonuç: Çalışmamızda SBS tekniğinin L-SIL lezyonlarının saptanmasında daha avantajlı olduğunu ve diğer sitolojik tanılar için smear teknikleri arasında bir fark olmadığı gösterilmiştir. Ayrıca KS, maliyet artışı konusu da dikkate alındığında SBS tekniğine iyi bir alternatif olabilir. 

Anahtar Kelimeler

• sıvı bazlı,smear,HPV,konvensiyonel

Kaynakça

1. 1. Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v10, Cancer Incidence and Mortality Worldwide: IARC Cancerbase No. 11. Lyon, France: International Agency for Research On Cancer; 2013.
2. 2. International Agency for Research on Cancer (IARC). 2007b. Natural history and epidemiology of HPV infection. IARC monographs on the evaluation of carcinogenic risks to humans, volume 90. Human papillomaviruses. Lyon: World Health Organization.pp 112–135.
3. 3. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74-108.
4. 4. Güner H, Taşkıran Ç. Epidemiology of cervical cancer and the role of human papilloma virus. Turk J Obstet Gynecol 2007; 4:11-19.
5. 5. Munoz N, Bosch FX, Castellsague X, et al. Against which human papillomavirus types shall we vaccinate and screen? Th e international perspective. Int J Cancer 2004;111:278–85.
6. 6. Munoz N, Bosch FX, de Sanjose´ S, et al, International Agency for Research on Cancer Multicenter Cervical Cancer Study Group. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med 2003; 348:518–527.
7. 7. Ozçelik B, Serin IS, Gökahmetoğlu S, Başbuğ M, Erez R. Human papillomavirus frequency of women at low risk of developing cervical cancer: A preliminary study from a Turkish university hospital. Eur J Gynaecol Oncol 2003;24:157-159.
8. 8. Dursun P, Senger SS, Arslan H, Kuşçu E, Ayhan A. Human papillomavirus (HPV) prevalence and types among Turkish women at a gynecology outpatient unit. BMC Infect Dis 2009;9:191.

9. 9. Demir ET, Ceyhan M, Simsek M, et al. Th e prevalence of diff erent HPV types in Turkish women with a normal Pap smear. J Med Virol 2012;84:1242-1247.
10. 10. Papanicolaou GN, Traut HF. Th e diagnostic value of vaginal smears in the carcinoma of the uterus. Am J Obstet Gynecol.1941;42, 193–206.
11. 11. K Kim K, Rigal RD, Patrick JR, et al. Th e changing trends of uterine cancer and cytology: a study of morbidity and mortality trends over a twenty year period. Cancer 1978; 42: 2439-2449.
12. 12. Lee KR, Ashfaq R, Birdsong GG, Corkill ME, McIntosh KM, Inhorn SL. Comparison of conventional Papanicolaou smears and a fl uid-based, thin-layer system for cervical cancer screening. Obstet Gynecol 1997; 90:278-784.
13. 13. Ring M, Bolger N, O’Donnell M, et al. Evaluation of liquid-based cytology in cervical screening of high-risk populations: a split study of colposcopy and genitourinary medicine populations. Cytopathology 2002;13:152-159.
14. 14. Ilter E, Midi A, Haliloglu B, et al. Comparison of conventional and liquid-based cytology: do the diagnostic benefits outweigh the financial aspect? Turk J Med Sci. 2012; 42 (Sup.1), 1200-1206.
15. 15. Siebers AG, Klinkhamer PJ, Greft e JM, et al. Comparison of liquid-based cytology with conventional cytology for detection of cervical cancer precursors: A randomized controlled trial. JAMA 2009;302:1757-1764.
16. 16. Confortini M, Bulgaresi P, Cariaggi MP, et al. Conventional pap smear and liquid-based cervical cytology smear: Comparison from the same patient. Tumori 2002;88:288- 290. 17. Moosa NY, Khattak N, Alam MI, et al. Comparison of cervical cell morphology using two diff erent cytology techniques for early detection of pre-cancerous lesions. Asian Pac J Cancer Prev 2014, 15, 975-981.
17. 18. Baandrup U, Bishop JW, Bonfiglio TA, et al. Sampling, sampling errors and specimen preparation. Acta Cytol 2000;4:944-948.
18. 19. Monsonego J, Autillo-Touati A, Bergeron C, et al. Liquidbased cytology for primary cervical cancer screening: a multi-centre study. Br J Cancer 2001;84:360-366.
19. 20. Nandini NM, Nandish SM, Pallavi P, et al. Manual liquid based cytology in primary screening for cervical cancer – a cost eff ective preposition for scarce resource settings. Asian Pac J Cancer Prev 2012;13:3645-3651.
20. 21. Hussein T, Desai M, Tomlinson A, Kitchener HC. Th e comparative diagnostic accuracy of conventional and liquid-based cytology in a colposcopic setting. BJOG 2005;112:1542-1546.
21. 22. Budak MŞ, Senturk MB, Kaya C, et al. A comparative study of conventional and liquid-based cervical cytology. Ginekol Pol 2016;87:190-193.
22. 23. Strander B, Andersson-Ellström A, Milsom I, Rådberg T, Ryd W. Liquid-based cytology versus conventional Papanicolaou smear in an organized screening program: a prospective randomized study. Cancer 2007;111:285-291.
23. 24- Kirschner B, Simonsen K, Junge J. Comparison of conventional Papanicolaou smear and SurePath liquid-based cytology in the Copenhagen population screening programme for cervical cancer. Cytopathology 2006;17, 187-194.
24. 25. Davey E, Barratt A, Irwig L, et al. Eff ect of study design and quality on unsatisfactory rates, cytology classifi cations, and accuracy in liquid-based versus conventional cervical cytology: A systemic review. Lancet 2006;367:122-32.
25. 26. Sharma J, Toi PCh, Siddaraju N, Sundareshan M, Habeebullah S. A comparative analysis of conventional and SurePath liquid. based cervicovaginal cytology: A study of 140 cases. J Cytol 2016;33:80-84.
26. 27. Strander B, Andersson-Ellström A, Milsom I, Rådberg T, Ryd W. Eff ect of study design and quality on unsatisfactory rates,cytology classifications, and accuracy in liquidbased versus conventional cervical cytology: a systematic review. Cancer 2007;111:285-291.
27. 28- Oh JK, Shin HR, Gong G, Sohn JN, Khang SK. Diagnostic accuracy of conventional Pap test, liquid-based cytology and human papillomavirus DNA testing in cervical cancer screening in Korea: a metaanalysis. Korean J Epidemiol. 2008;30, 178-187.
28. 29. Chichareon S, Herrero R, Muñoz N, et al. Risk factors for cervical cancer in Th ailand: a casecontrol study. J Natl Cancer Inst 1998; 90:50-57.
29. 30. Sigurdsson K. Is a liquid-based cytology more sensitive than a conventional Pap smear? Cytopathology 2013, 24, 254-263.
30. 31. Simion N, Căruntu ID, Avădănei ER, Balan R, Amălinei C. Conventional cytology versus liquid based cytology in cervical pathology: correspondences and inconsistencies in diagnosis, advantages and limits. Rom J Morphol Embryol 2014;55: 1331-1337.
31. 32. Schorge JO, Hossein Saboorian M, Hynan L, Ashfaq R. Th inPrep detection of cervical and endometrial adenocarcinoma: a retrospective cohort study. Cancer 2002;96: 338-343.
32. 33. Abulafia O, Pezzullo JC, Sherer DM. Performance of Th inPrep liquid-based cervical cytology in comparison with conventionally prepared Papanicolaou smears: a quantitative survey. Gynecol Oncol 2003; 90, 137-144