Hande KESER, Şahande ELAGÖZ, Ersin TUNCER, Hatice ÖZER, Handan AKER, Abdullah BOZTOSUN, Ayşe ÇİFTÇİ

Epitel hücre anormalliği saptanan servikal smear olgularında sitolojik tanı dağılımı ve sito- histopatolojik korelasyon

Amaç. Anabilim Dalımızda incelenen ve epitel hücre anormalliği saptanan servikovajinal smearsonuçlarının değerlendirilmesi ve histopatolojik incelemesi bulunan olgularda sito-histopatolojikkorelasyonun araştırılması. Yöntem. Ocak 2008-Mayıs 2011 tarihleri arasında CumhuriyetÜniversitesi Tıp Fakültesi Patoloji Anabilim Dalına gönderilen ve 2001 Bethesda sistemine göretanı alan toplam 8102 servikal smear örneğine ait raporlar retrospektif olarak incelendi. Epitelhücre anormalliği tesbit edilen 97 olgu çalışmaya dahil edildi. Bunlardan histopatolojik incelemesiolan 25 olguda sito-histopatolojik korelasyon araştırıldı. Bulgular. Toplam 8102 servikal smearin97sinde (%1,19) epitel hücre anormalliği saptandı. Epitel hücre anormalliği saptanan olguların54ü (%55,6) ASC-US, 14ü (%14,4) ASC-H, 14ü (%14,4) LSIL, 5i (%5,2) HSIL, 5i (%5,2)SCC, 3ü (%3,1) AGC ve 2si (%2,1) adenokarsinom, NOS olarak tanı almış idi. Bunlardanbiyopsi tanısı olan 25 olgunun 10unun (%40) nonneoplastik, 2sinin CIN I (%8), 1inin (%4) CINII, 3ünün (%12) CIN III ve 9unun (%36) invaziv karsinom olarak rapor edildiği saptandı. Busonuçlara göre ASC-US, ASC-H, LSIL, HSIL, SCC, AGC ve adenokarsinomun pozitif öngörmedeğeri sırasıyla %0, %50, %100, %80, %100, %0 ve %100 olarak saptandı. Sonuç. Servikalsmear de verilen karsinom, HSIL ve LSIL tanıları yüksek pozitif öngörme değerine sahip iken,serimizde bu değer ASC-US ve AGC tanıları için düşük bulunmuş, ancak bu gruplarda takipli olgusayısının çok az olması nedeniyle bu sonuç güvenilir kabul edilmemiştir.

Distribution of cytological diagnoses in cervical smears with epithelial cell abnormality and cyto-histopathological correlation

Aim. To evaluate the cervicovaginal smears with epithelial cell abnormality examined in ou department and to investigate the cyto-histopathological correlation of these cases with thei histopathological diagnoses. Method. The reports of cervical smears diagnosed according to 200 Bethesda System in Cumhuriyet University, Faculty of Medicine, Pathology Department between January 2008 and May 2011 were reviewed retrospectively (n: 8102). Among them, cases wit epithelial cell abnormality (n: 97) were included in the study. In 25 of these patients having als histopathological examinations, cyto-histopathological correlation was investigated. . Results Epithelial cell abnormality was detected in 97 (1.19) out of 8102 cervical smears. In th cytopathological examination, 54 patients (55.6%) had ASC-US, 14 had (14.4%) ASC-H, 14 ha (14.4%) LSIL, five had (5.2%) HSIL, five had (5.2%) squamous cell carcinoma (SCC), three ha (3.1%) atypical glandular cells (AGC) and two had (2.1%) adenocarcinoma, NOS Histopathological results of 25 patients revealed that 10 patients had (40%) nonneoplastic, two ha CIN I (8%), one had (4%) CIN II, three had (12%) CIN III and nine had (36%) malignant lesion The positive predictive values for the cases with diagnoses of ASC-US, ASC-H, LSIL, HSIL SCC, AGC and adenocarcinoma were 0%, 50%, 100%, 80%, 100%, 0% ve 100%, respectively Conclusion. Eventhough the positive predictive values in diagnosis of carcinoma, HSIL, and LSIL had been high, those values were found to be low in diagnosis of ASC-US and AGC in our series but since the number of follow-up cases were very few in these groups this result was accepted a not reliable.

PDF

___

1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005; 55: 74-108.
2. Wright TC, Kurman RJ, Ferenczy A. Precancerous Lesions of the Cervix. In: Kurman RJ editor Blausteins Pathology of the Female Genital Tract. 5th Edition New York, Springer-Verlag 2002; 253-324.
3. Solomon D, Davey D, Kurman R, Moriarty A, O'Connor D, Prey M, Raab S, Sherman M, Wilbur D, Wright T Jr, Young N; Forum Group Members; Bethesda 2001 Workshop. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA 2002; 287: 2114-219.
4. Gupta DK, Komaromy-Hiller G, Raab SS, Nath ME. Interobserver and intraobserver variability in the cytologic diagnosis of normal and abnormal metaplastic squamous cells in pap smears. Acta Cytol 2001; 45: 697-703.
5. Sebastião AP, Noronha L, Pinheiro DL, Collaço LM, de Carvalho NS, Bleggi- Torres LF. Influence of specimen adequacy on the diagnosis of ASCUS. Diagn Cytopathol 2004; 31: 155-8.
6. Ettler HC, Joseph MG, Downing PA, Suskin NG, Wright VC. Atypical squamous cells of undetermined significance: A cytohistological study in a colposcopy clinic. Diagn Cytopathol 1992; 21: 211-6.
7. Quddus MR, Sung CJ, Steinhoff MM, Lauchlan SC, Singer DB, Hutchinson ML. Atypical squamous metaplastic cells: reproducibility, outcome, and diagnostic features on ThinPrep Pap test. Cancer 2001; 93: 16-22.
8. Zuna RE, Sienko A, Lightfoot S, Gaiser M. Cervical smear interpretations in women with a histologic diagnosis of severe dysplasia: factors associated with discrepant interpretations. Cancer Cytopathol 2002; 96: 218-24.
9. Grenko RT, Abendroth CS, Frauenhoffer EE, Ruggiero FM, Zaino RJ. Variance in the interpretation of cervical biopsy specimens obtained for atypical squamous cells of undetermined significance. Am J Clin Pathol 2000; 114: 735-40.
10. Sherman ME, Solomon D, Schiffman M; ASCUS LSIL Triage Study Group. Qualification of ASCUS. A comparison of equivocal LSIL and equivocal HSIL cervical cytology in the ASCUS LSIL triage study. Am J Clin Pathol 2001; 116: 386-94.
11. Renshaw AA, Genest DR, Cibas ES. Should atypical squamous cells of undetermined significance (ASCUS) be subcategorized? Accuracy analysis of Papanicolaou smears using receiver operating characteristic curves and implications for the ASCUS/squamous intraepithelial lesion ratio. Am J Clin Pathol 2001; 116: 692-5.
12. Raab SS. Subcategorization of Papanicolaou tests diagnosed as atypical squamous cells of undetermined significance. Am J Clin Pathol 2001; 116: 631-4.
13. Kruse AJ, Baak JP, Helliesen T, Kjellevold KH, Robboy SJ. Prognostic value and reproducibility of koilocytosis in cervical intraepithelial neoplasia. Int J Gynecol Pathol 2003; 22: 236-9.
14. Nasiell K, Roger V, Nasiell M. Behavior of mild cervical dysplasia during long- term follow-up. Obstet Gynecol 1986; 67: 665-9.
15. Abali R, Bacanakgıl BH, Celık S, Aras O, Koca P, Boran B, Dursun N. Histopathological correlation of squamous cell abnormalities detected on cervical cytology. Turk Jour Pathol 2011; 27: 144-8.
16. Nasuti JF, Fleisher SR, Gupta PK. Atypical glandular cells of undetermined significance (agus): clinical considerations and cytohistologic correlation. Diagn Cytopathol 2002; 26: 186-90.
17. Obenson K, Abreo F, Grafton WD. Cytohistologic correlation between AGUS and biopsy-detected lesions in postmenopausal women. Acta Cytol 2000; 44: 41- 5.
18. Zweizig S, Noller K, Reale F, Collis S, Resseguie L. Neoplasia associated with atypical glandular cells of undetermined significance on cervical cytology. Gynecol Oncol 1997; 65: 314-8.