HPV 16 veya HPV 18 pozitif hastalarda servikal sitoloji ile final patoloji sonuçları arasındaki ilişkinin analizi: Tersiyer merkez deneyimi

Öz

Amaç: Ulusal tarama programı kapsamında kliniğimize başvuran HPV 16 veya HPV 18 pozitif hastaların sitoloji ve patoloji sonuçlarını analiz etmek.

Gereç ve Yöntem: Ocak 2014 ile Mayıs 2017 tarihleri arasında Jinekolokik Onkoloji Kliniği’mize başvuran HPV 16 veya HPV 18 pozitif olan hastaların verileri retrospektif olarak incelendi. Tüm hastalara kolposkopi yapıldı. Biopsi, endoservikal küretaj veya eksizyonel işlem sonuçlarından elde edilen en yüksek dereceli lezyon final patoloji olarak kabul edildi.

Bulgular: Çalışmaya dahil edilen 720 hastanın yaş ortalaması 41.96±8.67, parite ortalaması 2.39±1.58 idi. Hastaların 132 tanesi (%18.3) menopozdayken, 588 (% 81.7) tanesi premenopozaldi. Yüz otuz sekiz hastanın (%19.2) smear sonuçlarına ulaşılamadı. Ulaşılan smear sonuçları; 398 hastanın (%55.3) normal veya inflamasyon, 36 hastanın (%5) yetersiz, 91 hastanın (%12.6) ASCUS, 36 hastanın (%5) LGSIL, 11 hastanın (%1.5) ASC-H, 4 hastanın HGSIL (%0.6), 6 hastanın AGC (%0.8) idi. Final patolojide CIN 2+ lezyona neden olan anormal smear sonuçlarının dağılımı; ASCUS: 23 (%25.3), LGSIL: 13 (%36.1), ASC-H: 6 (%54.5), HGSIL: 4 (%100), AGC: 2 (%33.3) idi. HPV 16 veya 18 pozitif olan hastalardan anormal sitolojisi olanlarda, sitolojisi normal olanlara göre daha fazla CIN 2+ lezyon saptandı ve bu fark istatistiksel olarak anlamlı bulundu (48 (%32.4) vs 60 (%15.1) , OR:2.7 (1.74-4.2), p<0.001). Smear testi CIN 2+ lezyonların 60’ında (%55.6), invaziv kanserlerin ise 3 ‘ünde (%75) negatif olarak raporlanmıştı .

Sonuç: Sonuçlarımız HPV 16 veya 18 pozitif hastalarda sitoloji normal olsa bile kolposkopik değerlendirme yapılması görüşünü desteklemektedir.

Anahtar Kelimeler

• HPV
• HPV DNA taraması
• serviks kanseri

Analysis of the Relationship Between Cervical Cytology and Final Pathology Results in HPV 16 or HPV 18 Positive Patients: A Tertiary Center Experience

Abstract

Objective: To analyse the cytology and pathology results of HPV 16 or HPV 18 positive patients referred to our clinic as part of the national screening program.

Material and Methods: Data of patients with HPV 16 or HPV 18 positive who were referred to our Gynecologic Oncology Clinic between January 2014 and May 2017 were retrospectively reviewed. All patients underwent colposcopy. The highest grade lesion obtained from biopsy, endocervical curettage or excisional procedure results was accepted as the final pathology.

Results: The mean age of the 720 patients included in the study was 41.96 ± 8.67, and the parity average was 2.39 ± 1.58. One hundred and thirty-two of them (18.3%) were menopausal, and 588 (81.7%) were premenopausal. The smear results of 138 patients could not be reached. Reached smear results were; normal or inflammation in 39 patients (55.3%), insufficient in 36 patients (5%), ASCUS in 91 patients (12.6%), LGSIL in 36 patients (5%),  ASC-H in 11 patients (1.5%), HGSIL in 4 patients (0.6%), and AGC in 6 patients (0.8%). Distribution of abnormal smear results that cause CIN 2+ lesion in the final pathology were; ASCUS: 23 (25.3%), LGSIL: 13 (36.1%), ASC-H: 6 (54.5%), HGSIL: 4 (100%) and AGC: 2 (33.3%). More CIN 2+ lesions were detected in cases with abnormal cytology than those with normal cytology who are positive for HPV 16 or 18, and this difference was statistically significant (48 (32.4%) vs 60 (15.1%), OR: 2.7 ), p<0.01). The smear test was reported negative in 60 (55.6%) patients with CIN 2+, and three patients (75%) of the invasive cancers.

Conclusion: Our results support the idea of ​​performing colposcopic evaluation even if the cytology is normal in HPV 16 or 18 positive patients.

Keywords

• HPV
• HPV DNA screening
• cervical cancer

Kaynakça

1. 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(suppl 5): F12-F23.2. Schiffman M, Castle PE, Jeronimo J, Rodriguez AC, Wacholder S, Human papillomavirus and cervical cancer. Lancet. 2007;370 [9590]:890-907.3. Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, et al. Human papillomavirus is a necessary cause of invasive cervikal cancer worldwide. J Pathol. 1999;189 (1):12-19.4. 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;11:1048-1056.5. Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain JM 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. J Low Genit Tract Dis. 2012;16:175–204.6. 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;383:524-532.7. 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;136:178–82.8. Jemal A, Ward E, Thun M. Declining death rates reflect progress against cancer. PLoS One. 2010;5:e9584.9. 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.e41-46.e11.10. 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;6:281–90.11. Lee S, Kim JW, Hong JH etal. Clinical significance of HPV DNA cotesting in Korean women with ASCUS or ASC-H. Diagn Cytopathol. 2014;42:1058–1062.12. Wright TC, Stoler MH, Behrens CM, Sharma A, Zhang G, Wright TL. Primary cervical cancer screening with human papillomavirus: end of study results from the ATHENA study using HPV as the first-line screening test. Gynecol Oncol. 2015; 136:189-197.13. 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;45:580-586.14. 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, 2018.15. Gultekin M, Zayifoglu Karaca M, Kucukyildiz I, Dundar S, Boztas G, Semra Turan H, Hacikamiloglu E, Murtuza K, Keskinkilic B, Sencan I. 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.