ASC-H (YÜKSEK DERECELİ LEZYONUN DIŞLANAMADIĞI ATİPİK HÜCRE) SİTOLOJİ SONUÇLARININ HİSTOLOJİK OLARAK DEĞERLENDİRİLMESİ

Yıl 2016, Cilt: 19 Sayı: 4, 155 - 158, 22.05.2018

Aykut Tuncer Ali Ayhan

Öz

Amaç: Servikal sitolojisinde yüksek dereceli squamöz intraepitelial lezyon dışlanamayan atipik skuamöz hücreler (ASC-H) saptanan hastalarda
histolojide servikal intraepitelial lezyon grade ≥2 (≥ CIN 2) tanısının belirleyicilerini ortaya koymaktır.
Material ve Metod: 2007- 2015 yıllarında servikal sitoloji sonucu ASC-H olup kolposkopi ile değerlendirilen olgular çalışmaya dahil edildi.
Hastaların yaşı, paritesi, menapoz durumu, medeni hali, sigara kullanımı, yüksek riskli human papilloma virüs taşıyıcılığı (hrHPV) ileri doğru
regresyon methodu ile analiz edildi. Anlamlılık p <0.05 değerinde hesaplandı.
Bulgular: Sitoloji sonucu ASC-H olan 93 hastaya kolposkopik biyopsi yapıldı ve çalışma kapsamında değerlendirildi. Hastaların ortalama
yaşı 39.37±1.03 (20-63) olup 32 hasta (% 36.8) sigara kullanmaktaydı. HPV testi 30 hastada yapılmıştı ve 10 hastada (% 33.3) hrHPV tespit
edildi. Kolposkopik histoloji tanısı sonucu 44 (% 47.3) hastada normal, 10 (% 10.8), hastada CIN 1, 24 (% 25.8) hastada CIN 2, 12 (% 12.9)
hastada CIN 3, 3 hastada da (% 3.2) serviks kanseri tespit edildi. ≥ CIN 2 saptanan hastaların ortalama yaşı (41.13±10.45), ≤ CIN 1 saptanan
hastaların ortalama yaşı (36.92±8.61)’ndan yüksekti (p=0.042). HrHPV (+) olan 10 hastadan 9’unda (% 90), buna karşın hrHPV (-) olan 20
hastadan 2’sinde (% 10) ≥ CIN 2 lezyonu olup (p <0.001), sigara kullanan 32 hastadan 18’inde (% 56.2), buna karşın sigara kullanmayan
55 hastadan 18’inde (% 32.7) ≥CIN 2 lezyon tespit edildi (p <0.03). Regresyon analiz sonucucuna göre tek belirleyici (+) hrHPV test olarak
bulundu [vs. (-) hrHPVtest; OR 6.351; 95% CI 3.673–8.947, p=0.014].
Sonuç: HPV + olan ASC-H sitolojisine sahip kadınlarda ≥ CIN 2 lezyon riski yüksek olduğundan kolposkopik muayene, biyopsi ve patolojik
değerlendirme dikkatli yapılmalıdır

Anahtar Kelimeler

HPV, serviks kanseri, kolposkopi, ASC-H

HISTOLOGIC EVALUATION OF ATYPICAL SQUAMOUS CELLS-CANNOT EXCLUDE HIGH-GRADE SQUAMOUS INTRAEPITHELIAL LESION (ASC-H) CYTOLOGY

Öz

Aim: To estimate predictors for histological diagnosis of cervical intraepithelial neoplasia of grade ≥2 (≥CIN 2) in patients with atypical
squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H) on cervical cytology.
Materials and Methods: We retrospectively reviewed the patients with ASC-H who had undergone colposcopic biopsy between the
years 2007-2015. Age, parity, menapousal status, marriage status, smoking habitus, high risk Human Papilloma Virus (hrHPV) status were
analized with forward likelihood ratio method and significance was set at p <0.05.
Results: 93 patients with ASC-H were undergone colposcopy-guided bioopsy. Mean age of the patients was 39.37±1.03 (20-63). HPV test
was performed to 30 patients and 10 (33.3 % ) were HR-HPV positive (+). Histologic diagnosis were reported as normal in 44 (47.3 % ), CIN
1 in 10 (10.8 % ), CIN 2 in 24 (25.8 % ), CIN 3 in 12 (12.9 % ) and cervical cancer in 3 (3.2 % ) patients. Mean age of ≥ CIN 2 patients were
41.13±10.45 compared with 36.92±8.61 for ≤ CIN 1 patients (p=0.042). 9 of 10 (90 % ) HR-HPV (+) patients and 18 of 32 (56.2 % ) smokers
had ≥ CIN 2 lesions whereas two of 20 (10 % ) HR-HPV negative (-) patients and 18 of 55 (32.7 % ) non-smokers had ≥ CIN 2 lesions (p
values were, <0.001 and 0.03 for HR-HPV and smoking status, respectively). According to regression analysis (+) HR-HPV test was the only
predictor [vs. (-) HR-HPVtest; OR 6.351; 95% CI 3.673–8.947, p=0.014].
Conclusion: Colposcopic evaluation, biopsy and histological diagnosis should be performed carefully for ASC-H patients, especially if
they are HR-HPV positive.

Anahtar Kelimeler

HPV, cervical cancer, colposcopy, ASC-H.

Kaynakça

• 1. Globocan 2012: Estimated Cancer Incidence, Mortality and Prevalence worldwide in 2012: http://globocan.iarc. fr/Default.aspx.
• 2. Ciatto S, Cecchini S, Iossa A, et al. Trends in cervical cancer incidence in the district of Florence. Eur J Cancer 1995;31A(3):354-5.
• 3. Solomon D, Davrey D, Kurman R, et al. Th e 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA 2002; 287: 2114-9.
• 4. Davey DD, Greenspan DL, Kurtycz DF, Husain M, Austin RM. Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion: review of ancillary testing modalities and implications for follow-up. J Low Genit Tract Dis 2010; 14: 206-14.
• 5. Galliano GE, Moatamed NA, Lee S, Salami N, Apple SK. Refl ex high risk HPV testing in atypical squamous cells, cannot exclude high grade intraepithelial lesion: a large institution’s experience with the significance of this oft en ordered test. Acta Cytol 2011;55:167–172
• 6. Mokhtar GA, Delatour NL, Assiri AH, Gilliatt MA, Senterman M, Islam S. Atypical squamous cells, cannot exclude high- grade squamous intraepithelial lesion: cytohistologic correlation study with diagnostic pitfalls. Acta Cytol 2008;52:169–177
• 7. McHale MT, Souther J, Elkas JC, Monk BJ, Harrison TA (2007) Is atypical squamous cells that cannot exclude high-grade squa- mous intraepithelial lesion clinically significant? J Low Genit Tract Dis 11:86–89
• 8. Gilani SM, Tashjian R, Fathallah L. Cervical cytology wiyh a diagnosis of atypical cells, cannot exclude highgrade squamous intraepithelial lesion (ASC-H): a followup study with corresponding histology and significance of predicting dysplasia by human papillomavirus (HPV) DNA testing. Arch Gynecol Obstet 2014; 289: 645-8.
• 9. Massad LS, Einstein MH, Huh WK, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2013; 17:S1–S27.
• 10. Wu HH, Allen SL, Kirkpatrick JL, Elsheikh TM. Refl ex high-risk human papilloma virus DNA test is useful in the triage of women with atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion. Diagn Cytopathol. 2006; 34:707–10.
• 11. Reid-Nicholson M, Gatscha RM, Riedel ER, Lin O. Atypical squamous cells, cannot exclude high grade intraepithelial lesion (ASC-H): Does HPV matter? Diagn Cytopathol 2007; 35:1–5.
• 12. Liman AK, Giampoli EJ, Bonfiglio TA. Should women with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion, receive refl ex human papillomavirus-DNA testing? Cancer 2005; 105:457–60.
• 13. Xu L, Verdoodt F, Wentzensen N, Bergeron C, Arbyn M. Triage of ASC-H: a meta-analysis of the accuracy of hrHPV testing and other markers to detect cervical precancer. Cancer Cytopathol 2016; 124(4):261-272.
• 14. Patton AL, Duncan L, Bloom L, Phaneuf G, Zafar N. Atypical squamous cells, cannot exclude a high-grade intraepithe- lial lesion and its clinical significance in postmenopausal, pregnant, postpartum, and contraceptive-use patients. Cancer 2008; 114:481–488.