Association of Cervical Screening Results with Colposcopic Findings

Objective: Cervical cancer is the fourth most common female cancer. In addition to early cancer diagnosis, the screening strategy of cervical cancer is based on early diagnosis of precancerous lesions [high-grade cervical lesions (HSIL)] to prevent cancer progression. The evaluation of clinical findings is very important for the monitoring and further modifications of the present cancer screening programs. This study aimed to review the relationship between the admission characteristics, human papilloma virus (HPV) types, Papanicolaou smear results and the colposcopic diagnoses of the patients who were referred for colposcopy. Method: The characteristics and colposcopic diagnoses of 420 patients who were referred to a University Hospital between the years of 2016 and 2018 upon the detection of high-risk-HPV DNA positivity were evaluated retrospectively. The clinical properties, colposcopic findings, and sociodemographic features of the patients with HSIL and cancer were obtained through the file records. Results: During the study period, 21 patients with carcinoma in situ and/ or cancer and 131 patients with HSIL had been diagnosed. When the patients with HSIL were analyzed, it was found that 76.3% (n=100) of the patients had HPV type 16 and/or 18 positivity, and 23.7% (n=31) of the patients had other types of high risk HPV positivity. Besides, it was observed that smear results were negative in approximately half of the cases (n=57, 50.9%). When different triage options to detect HSIL and above lesions were compared between each other, the highest sensitivity value (92.11%) and the highest negative predictive value (84.21%) were obtained by the triage of the patients with HPV 16 and/or 18 positivity and/or ASC-US and above. It was also observed that cytology alone was the triage method with the lowest sensitivity (30.92%) Conclusion: The results of the present study were compatible with the data of the current national cervical cancer screening program. Referring patients with HPV 16/18 and/or abnormal cytology to detect HSIL is a highly sensitive triage method. However, it should be considered that, even in this triage method, approximately 8% of the cases can be missed.

Servikal Tarama Sonuçlarının Kolposkopik Bulgular ile İlişkisi

Amaç: Serviks kanseri en sık görülen dördüncü kadın kanseridir. Serviks kanserinin tarama stratejisi, erken kanser tanısına ek olarak kansere progresyonun önlenmesi amacıyla prekanseröz lezyonların [yüksek dereceli servikal lezyonlar (HSIL)] erken tanısı temelinde oluşturulmuştur. Klinik bulguların değerlendirilmesi, kanser tarama programının monitorizasyonu ve gelecekteki modifikasyonlar için oldukça önemlidir. Bu çalışmada kolposkopi için refere edilen hastaların başvuru özellikleri, insan papilloma virüsü (HPV) tipleri ve Papanicolaou smear sonuçları ile kolposkopik değerlendirme bulguları arasındaki ilişkinin değerlendirilmesi amaçlanmıştır. Yöntem: 2016-2018 yılları arasında yüksek riskli HPV DNA pozitifliği saptanması üzerine bir üniversite hastanesine refere edilen toplamda 420 hastanın başvuru özellikleri ve kolposkopik tanıları retrospektif olarak değerlendirildi. HSIL ve kanser saptanan olguların sosyodemografik ve klinik özellikleri ile kolposkopi bulgularına dosya kayıtları üzerinden ulaşıldı. Bulgular: Çalışma süresince hastaların 21 tanesinde kanser ya da karsinoma in situ, 131 tanesinde HSIL saptandı. HSIL saptanan olgular incelendiğinde, hastaların %76,3’ünde (n=100) HPV tip 16 ve/veya 18 pozitif olduğu ve hastaların %23,7’sinde (n=31) ise diğer yüksek riskli HPV pozitifliği olduğu izlendi. Yine bu olguların Pap smear sonuçları incelendiğinde olguların yaklaşık yarısında (n=57, %50,9) smear sonucunun negatif olduğu izlendi. Kolposkopi için yönlendirilen tüm hastalarda, HSIL ve üzeri lezyonları yakalamak amacıyla uygulanabilecek diğer triyaj yöntemleri birbirleri ile karşılaştırıldığında; en yüksek sensitivite değeri (%92,11) ve en yüksek negatif prediktif değer (%84,21) HPV 16 ve/veya 18 pozitifliği ve Pap smear sonucu ASCUS ve üzeri olguların triyajı ile elde edildi. Tek başına sitolojinin ise en düşük sensitiviteye (%30,92) sahip triyaj yöntemi olduğu izlendi. Sonuç: Çalışmamız güncel ulusal servikal kanser tarama programının verileri ile uyumludur. HSIL olgularının saptanabilmesi için HPV 16/18 ve/veya anormal sitoloji saptanan hastaların refere edilmesi oldukça sensitif bir triyaj yöntemidir. Ancak bu triyaj yönteminde bile olguların yaklaşık %8’inin atlanabileceği göz önünde bulundurulmalıdır.

Kaynakça

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