Sitolojileri Normal Kadınlarda Yüksek Riskli Hpv Pozitifliği Varlığında Servikal Patolojilerin Karşılaştırılması

Yıl 2021, Cilt: 22 Sayı: 1, 19 - 26, 22.03.2021

Eda Kılınçlı Pınar Kadiroğulları , Necip Deniz Sedat Akgol , Volkan Ülker Ozgur Akbayir

Öz

Amaç: Servıks kanseri tarama programında Hpv 16-18 tipi pozitif hastalara kolposkopi yapılmaktadır. Smear negatif olan, Tip 16-18 dışı yüksek riskli Hpv pozitifliği olan hastalar 1 yıl sonra kotest ile değerlendirilmektedir. Biz çalışmamız ile kolposkopi yapılan; tip 16-18 Hpv pozitifliği ve tip 16-18 dışı yüksek riskli Hpv pozitifliği olan hastaların sonuçlarını karşılaştırmayı hedefledik.
Gereç ve Yöntemler: Sitolojileri normal olan; tip 16-18 dışı HR-HPV tip pozitifliği olan 192 hastanın, kolposkopiye bağlı çıkan histopatolojik bulguları, tip 16-18 HR-HPV pozitifliği olan 217 hastanın kolposkopiye bağlı çıkan histopatolojik bulguları ile karşılaştırdı. Demografik veriler, body mass indeksi (BMI) ve histolojik sınıflandırma ile ilgili veriler kaydedildi.

Sonuçlar: Yaş ortalaması 41.6± 8.5, BMI ları 29.2±4.4 idi. Değerlendirilen 409 kadından 217'si HPV tip 16/18 (% 53), 192'si non-16/18 tip (%47) için pozitifti. Tip 16-18 HR-HPV pozitifliği olan kadınlarda yapılan kolposkopik biyopsi sonuçları; normal biyopsi sonucu 147(%67.7), invaziv serviks karsinomu 2(%0.9) olarak saptandı. Tip non-16-18 HR-HPV pozitifliği olan kadınlarda ise normal biyopsi sonucu 159(%83), invaziv serviks karsinomu 1(%0.5) olarak saptandı. Grup 1’de anormal biyopsi sonuçları anlamlı olarak daha fazla idi (p=0.003).

Tartışma: HPV 16 ve 18 ile oluşan enfeksiyonlar, CIN 2 veya daha ileri (≥CIN 2) lezyonlar için en yüksek risk ile ilişkilidir. Kolposkopik muayene yaptığımız tip 16/18 HR-HPV hastalarından 2 tanesinde ve non-tip 16/18 HR-HPV hastalarının 1 tanesinde invaziv serviks kanseri saptadık. Bu durum invazive servikal kanseri saptamada kolposkopik yönetim sonuçlarının her iki grupta da farklı olmadığını ve bu şekilde invaziv serviks kanserini erken yakalayabileceğimizi düşündürüyor. Çalışmamızda hasta sayısının az olması nedeniyle bu konuda gelecekte daha kapsamlı çalışmaların yapılması ve kolposkopinin yüksek riskli HPV’nin tüm tiplerinde uygulanabilirliğinin araştırılması gerektiğini düşünmekteyiz.

Anahtar Kelimeler

Yüksek Riskli HPV, Servical İntraepitelyal Neoplazi, Servical Neoplasm, Kolposkopi, Human Papillomavirus

Comparison of Cervical Pathologies in Presence of High-Risk HPV Positivity in Women with Normal Cytology

Öz

Aim: Regarding the cervical cancer screening program, who are HPV-16/18 positive, undergo colposcopy. Patients, who have a negative smear but high-risk HPV positivity except for type 16-18, are examined with cotesting one year later. In this study, our objective was to compare the results of patients, who had type 16/18 HPV positivity and non-16/18 HPV positivity.
Methods: The results of 409 patients, who had high-risk HPV (HR-HPV) positivity and negative cytology, were evaluated retrospectively. Demographic data, body mass index (BMI) and histological classification were recorded. The histopathological findings obtained with the colposcopic examination in patients (n=192), who had normal cytology and non-16/18 HR-HPV positivity, were compared with the histopathological findings obtained with a colposcopic examination in patients (n=217), who had type 16-18 HR-HPV positivity.
Results: The mean age and BMI were 41.6±8.5 years and 29.2±4.4. A total of 409 women were assessed and 217 of them had type 16-18 HR-HPV positivity (53%) and 192 had non-16/18 HR-HPV positivity (47%). The following colposcopic biopsy results were obtained in women with type 16-18 HR-HPV positivity: 147 patients had normal biopsy results (67.7%); 68(31.4%) patients had premalignant cervical lesions and 2 patients had invasive cervix carcinoma (0.9%). Regarding the women with non-16/18 HR-HPV positivity, the colposcopic biopsy results were as follows: 159 patients had normal biopsy results (83%); 32(16.6%) patients had premalignant cervical lesions and 1 patient had invasive cervix carcinoma (0.5%). The rate of abnormal biopsy results was significantly higher in Group1 (p=0.003).
Conclusions: Infections caused by HPV16/18, ≥CIN2 lesions are related to high risk. We determined invasive cervix carcinoma in 2 of patients with type 16-18 HR-HPV positivity and in 1 of patients with non-16/18 HR-HPV positivity. Due to the small number of patients in our study, we believe that there is a need for more comprehensive studies and for the investigation of the benefits of the colposcopy in all types of HR-HPV infections.

Anahtar Kelimeler

High-Risk HPV, Cervical Intraepithelial Neoplasia, Human Papillomavirus, Cervical Neoplasm, Colposcopy

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