Remzi ATILGAN, GÖKHAN ARTAŞ, Selçuk KAPLAN, Zehra Sema ÖZKAN, SALİH BURÇİN KAVAK, Behzat CAN, İBRAHİM HANİFİ ÖZERCAN, EKREM SAPMAZ

Thinprep ve konvansiyonel servikovajinal smearlarin histopatolojik sonuçlarının karşılaştırılması

Amaç : Thinprep otomatik siste m (TİS) ve konvansiyonel yöntemle alınan servikovajinal smearlarda epitelyal hücre anormalliği tespit edilen olguların histopatolojik sonuçlarının karşılaştırılması. Gereç ve Yöntem: Ağustos 2011 - Aralık 2013 tarihleri arasında 2001 Bethesda sistemi (TBS III) e göre epitelyal hücre anormalliği saptanan 145 olguya kliniğimizde kolposkopik inceleme ve biyopsi yapıldı. Örneklerin 54 ünü TİS tekniğine göre, geri kalan 91 ini ise ko nvansiyonel yönteme göre servikovajinal smearında epitelyal hücre anormalliği saptanan olgular oluşturdu. Bunların histopatolojik inceleme sonuçları değerlendirilerek pozitif tanı oranları karşılaştırıldı. Bulgular: TİS grubunda tespit edilen ASCUS olgularında %56 pozitiflik, ASC - H de %50, LSIL de %66 ve HSIL de %100 pozitiflik saptandı. ASCUS olgularında en şiddetli patoloji CIN 3, LSIL olgularında mikroinvaziv karsinom, HSIL olgularında invazif serviks kanseri idi. Bu grupta sedece bir AGUS olgusu vardı ve bu olguda da kronik servisit saptandı. Konvansiyonel grupta tespit edile n ASCUS olgularında %35 pozitiflik, ASC- H de %60, LSIL de %73 ve HSIL de %100 pozitiflik saptandı. ASCUS olgularında en şiddetli patoloji CIN 3, LSIL olgularında mikroinvaziv karsinom, HSIL olgularında ise invazif serviks kanseri idi. Bu grupta kolposko pi yapılan dört AGUS olgusunun tümünde de kronik servisit bulguları mevcuttu. Sonuç: TİS veya konvansiyonel yöntemle alınan servikovajinal smearlarda ASC -H, LSIL ve HSILde olduğu gibi, ASCUS olgularında da şiddetli displazi mevcut olabilir. Pozitif tanı o ranı TİSte tespit edilen ASCUS olgularında daha yüksek olabilir. Bu nedenle bu olgularda da mutlaka kolposkopik inceleme ve şüpheli alanlardan biyopsi alınmasını öneriyoruz.

Comparison of histopathological results of thinprep and conventional cervicovaginal smears

Objective: The comparison of colposcopy results of epithelial cell abnormalities that were detected at automatic thinprep systems (TIS) and conventional cervicovaginal smears. Material and Method : Colposcopic evaluation and biopsy were made to 145 patients that were diagnosed as epithelial cell abnormality according to the 2001 Bethesda system (TBS III) between August 2011 - December 2013. Fifty -four of these patients were evaluated by TIS and the remaining 91 by conventıonal cervıcovagınal smear. We evaluated and compared the positive diagnosis rates of histopathological examination results. Results: In TIS group, 56% positivity was identified in patients with ASCUS, 50% in ASC- H, 66% in LSIL and 100% in HSIL. The most severe pathology in patients with ASCUS was CIN-3, micro -invasive carcinoma in LSIL, invasive cervical carcinoma in HSIL. Only an AGUS case was in this group and the pathology result was chronic cervicitis. In conventıonal cervıcovagınal smears group, 35% positivity was identified in patients with ASCUS, 60% in ASC- H, %73 in LSIL and %100 in HSIL. The most severe pathology in patients with ASCUS was CIN- 3, micro -invasive carcinoma in LSIL, invasive cervical carcinoma in HSIL. Four AGUS cases were in this group and their pathology results were chronic cervicitis. Conclusion: Severe dysplasia can be found with ASCUS as ASC- H, LSIL and HSIL at that were detected with TIS and conventional cervicovagin al smears. The positivity rate of ASCUS wa s found a higher The at TIS than conventıonal cervicovaginal smears. Therefore we suggest colposcopic examination and if necessary biopsy for these patients.

PDF

___

1. Jemal A, Bray F, Center M, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011; 61: 69 -90.
2. Valdespino VM, Valdespino VE. Cervical cancer screening: state of the art. Curr Opin - Obstet Gynecol 2006; 18: 35 -40.
3. Solomon D, Davey D, Kurman R, et al. Bethesda 2001 Workshop: the 2001 Bethesda system-terminology for reporting the results of cervical cytology. JAMA 2002; 287: 2114 -9.
4. Karabacak T, Aydın Ö, Düşme z D, P olat A, Cinel L, Eğilmez R. [Limitation, inadequacy rates and reasons in cervicovaginal smears (2832 cases) ] Patoloji Bülteni 2001; 18: 22-5.
5. McNeeley SG. New cervical cancer screening techniques. Am J Obstet Gynecol 2003; 189: 40 -1.
6. Richartın Richart RM. Natural history of cervical intraepithelial neoplasia. Clin Obstet Gynecol 1967; 10: 748 - 84.
7. Anschau F, Guimarães Gonçalves MA. Discordance between cytology and biopsy histology of the cervix: what to consider and what to do. Acta Cytol 2011; 55: 158 -62.
8. Turkish Cervical Cancer and Cervical Cytology Research Group. Prevalence of cervical cytological abnormalities in Turkey. Int J Gnecol and Obs 2009; 106: 206 -9.
9. Atilgan R, Celik A, Boztosun A, Ilter E, Yalta T, Ozercan R. Evaluation of cervical cytological abnormalities in Turkish population. Indian J Pathol Microbiol 2012; 55: 52-5.
10. ASCUS - LSIL Traige Study (ALTS) Group. A randomized trial on the management of low- grade squ- amous intraepithelial lesion cytology interpretations. Am J Obstet Gynecol 2003; 188: 1393 - 400.
11. Abike F, Engin AB, Dunder I, Tapisiz OL, Aslan C, Kutluay L. Human papilloma virus persistence and neopte - rin, folate and homocysteine levels in cervical dysplasias. Arch Gynecol Obstet 2011; 284: 209 -14.
12. Infantolino C, Fabris P, Infantolino D, et al. Usefulness of human papillomavirus testing in the screening of cervical cancer precursor lesions: a retrospective study in 324 cases. Eur J Obstet Gynecol Reprod Biol 2000; 93: 71 -5.
13. Fallani MG, Pena C, Fambrini M, Marchionni M. Cervical cytologic reports of ASCUS and LSIL. Cyto - histological correlation and implication for management. Minerva Ginecol 2002; 54: 263 -9.
14. Yaltı S, Gürbüz B, Bilgiç R, Çakar Y, Eren S. Evaluation of cytologic screening results of the cervix. Int J Gynecol Cancer 2005; 15: 292 -4.
15. Boztosun A, Mutlu AE, Özer H, Aker H, Yanık A. [The evaluation of colposcopic biopsy results in patients with epithelial cell abnormalities at cervicovaginal smear] Türk Jinekolojik Onkoloji Derg 2012; 15: 13 -9.
16. Yazıcı F, Tazegül A, Esen H, Çelik Ç. [The Evaluation of the Biopsy Results Taken Under Colposcopy in Patients with Abnormal Cervicovaginal Smear Results ] Turkiye Klinikleri J Gynecol Obst 2011; 21: 83 -8.
17. Duggan MA, Khalil M, Brasher PM, Nation JG. ThinPrep yield o f confirmed tests however was almost 50% higher than the conventional test. Cytopathology 2006; 17: 73 -81.
18. Koltz BR, Russell DK, Lu N, Bonfiglio TA, Varghese S. Effect of Thin Prep(®) imaging system on laboratory rate and relative sensitivity of atypical squamous cells, high- grade squamous intraepithelial lesion not excluded and high - grade squamous intraepithelial lesion interpretations. Cytojournal 2013; 10: 6.
19. Miller FS, Nagel LE, Kenny-Moynihan MB. Implementation of the ThinPrep imaging system in a hig h volume metropolitan laboratory. Diagn Cytopathol 2007; 35: 213 -7.