Anormal PAP-smear ve/veya HPV Pozitifliği Olan Kadınların Kolposkopik Muayeneleri ve Servikal Histopatoloji Sonuçlarının Değerlendirilmesi: Amasya Örneği

Amaç: Kliniğimize anormal PAP-smear ve/veya insan papilloma virüsü (HPV) pozitifliği ile başvuran kadınların kolposkopik muayeneleri ve servikal histopatoloji sonuçlarını analiz etmek. Gereç ve Yöntemler: Ocak 2018 ve Ocak 2020 tarihleri arasında jinekoloji polikliniklerimize başvurmuş smear sonucu: atipik skuamoz hücreler (ASCUS), düşük dereceli servikal intraepitelyal lezyon (LGSIL), yüksek dereceli servikal intraepitelyal lezyon (HGSIL) ve atipik skuamoz hücreler-yüksek dereceli lezyonun ekarte edilemediği (ASC-H) olan ve/veya HPV testi:16, 18, ve diğer tipleri pozitif olan kadınların yapılmış kolposkopik muayene bulguları, punch biyopsi sayıları ve en nihai histopatolojik sonuçları retrospektif olarak incelendi. Bulguların karşılaştırılmasında Ki-kare testi kullanıldı. Bulgular: Çalışmaya dahil edilen 214 hastanın yaş ortalaması 46.54 ± 10.765 idi. PAP-smear sonuçları sırasıyla; 71 (%33.2) hastanın ASCUS, 2 (%0.9) hastanın ASC-H, 23 (%10.7) hastanın LGSIL, 8 (%3.7) hastanın HGSIL ve 110 (%51.4) hastanın normal veya inflamasyon şeklinde idi. HPV 16 pozitifliği 58 (%27.1), HPV 18 pozitifliği 12 (%5.6), diğer yüksek risk tip HPV pozitifliği 84 (%39.3), diğer tip HPV pozitifliği ise 53 (%24.8) kadında mevcuttu. Kolposkopi bulgusu olarak 60 (%28) kadında lökoplaki, 40 (%18.7) kadında beneklenme, 26 (%12.1) kadında mozaik görünüm ve 24 (%11.2) kadında atipik damarlanma mevcuttu. Yaptığımız tüm kolposkopilerden biyopsi alındığını tespit ettik. 53 (%24.8) kadından tek punch biyopsi alınmışken, 161 (%75.2) kadından çoklu punch biyopsi alınmıştı. Histopatolojik sonuçlar 45 (%21) kadında LGSIL, 15 (%7) kadında HGSIL ve 1 (%0.5) kadında karsinom olarak raporlanmıştı. Kolposkopik muayene bulguları ile punch biyopsi alma sayısı arasında ilişki izlenmedi (p=0.655). Ancak, punch biyopsi sayısı arttıkça LGSIL, HGSIL ve karsinom olasılığı da artmaktaydı (p=0.006). Sonuç: Lökoplaki en sık görülen kolposkopik bulguydu. Klinikte, jinekologlar birden fazla biyopsi almaktan yanaydı. LGSIL en sık karşılaşılan histo-patolojik sonuçtu. Kolposkopi muayene bulguları punch biyopsi sayısını etkilememekteydi, ancak punch biyopsi sayısı arttıkça servikal premalign ve malign lezyonları yakalama olasılığının da arttığı görüldü.

The Evaluation of Colposcopic Examinations and Cervical Histopathology Results of Women With Abnormal PAP-smear and/or HPV Positivity: A Sample From Amasya

Aim: To analyze the colposcopic examinations and cervical histopathology results of women who presented at our clinic with abnormal PAP-smear and/or human papilloma virus (HPV) positivity. Material and Methods: A retrospective examination was made of the colposcopy findings, number of punch biopsies, and final histo-pathological results of patients who presented at the gynecology polyclinic between January 2018 and January 2020 with a smear result showing atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesions (LGSIL), high-grade squamous intraepithelial lesions (HGSIL), and atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H), and/or HPV test was 16, 18 and other types of positivity. The Chi-square test was applied in the comparisons of the findings. Results: Evaluation was made of 214 patients with a mean age of 46.54±10.76 years. The PAPsmear results were recorded as ASCUS in 71 (33.2%) patients, ASC-H in 2 (0.9%), LGSIL in 23 (10.7%), HGSIL in 8 (3.7%) and normal or showing inflammation in 110 (51.4%). HPV 16 positivity was determined in 58 (27.1%) patients, HPV 18 positivity in 12 (5.6%), other high-risk type (HR-) HPV positivity in 84 (39.3%) and other type HPV positivity in 53 (24.8%). The colposcopy findings were recorded as leukoplakia in 60 (28%) patients, a punctuation appearance in 40 (18.7%), mosaic appearance in 26 (12.1%), and atypical vascularization in 24 (11.2%). We detected that biopsy was taken from all the colposcopies we made. A single punch biopsy was taken from 53 (24.8%) patients, and multiple biopsies were taken from 161 (75.2%). The histo-pathological results were reported as LGSIL in 45 (21%) patients, HGSIL in 15 (7%) and carcinoma in 1 (0.5%). No correlation was determined between the colposcopic examination findings and the number of punch biopsies (p=0.655). As the number of punch biopsies increased, so the probability of LGSIL, HGSIL and carcinoma increased (p=0.006). Conclusion: Leukoplakia was the most common colposcopic finding. Gynecologists were in favor of taking multiple biopsies in the clinic. LGSIL was the most encountered histo-pathological result. Colposcopy examination findings did not affect the number of punch biopsies, but it was observed that the possibility of detecting cervical premalignant and malignant lesions increased as the number of punch biopsies increased.

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