Hacer UYANIKOĞLU, Ceyhun NUMANOĞLU, Ahmet GÜLKILIK

Servikal Kanser Taramasında Asetikasit Sonrası İnspeksiyon ile Servikal Smearin Karşılaştırılması

Amaç: Bu çalışmada servikal kanser taramasında asetik asit uygulaması sonrası vizüel inspeksiyon (VIA) yöntemi ile geleneksel pap smearin karşılaştırılması amaçlanmıştır. Materyal Metod: Hastanemize başvuran 30-55 yaş arası, histerektomi ve konizasyon geçirmemiş, vajinal kanaması olmayan 95 hastadan önce servikal smear alındı, daha sonra %3'lük asetik asit uygulanarak vizüel inspeksiyonla asetowhite alan tarandı. Son olarak hastalardan, şüpheli alanlardan ve şüpheli alan yoksa 4 kadrandan (saat 12, 15, 18, 21 ) randomize biopsi alındı. Test doğruluğunu saptamada altın standart olarak biopsi kullanıldı. Bulgular: Taranan 95 hastanın yaş ortalaması 41.06 (yaş dağılımı 30-55), Ortalama evlilik yılı 20.28 (1-42) idi. Ortalama gebelik sayısı 4.03; parite sayısı 2.50 idi. 33 hasta (%34.73) sigara içiyor; 38 hasta (%40) hayatlarının herhangi bir döneminde oral kontraseptif kullanmış idi. Toplam 95 hastanın 51 tanesi (%53.6) VIApozitif, 38 tanesi (%40) smear pozitif, 31 (%32.6) tanesi biopsi pozitif idi. VIA'nın sensitivitesi %56.8, spesifitesi %95.4, pozitif prediktif değeri % 93.5, negatif prediktif değeri % 65.6 idi. Smearin sensitivitesi %47.3, spesifitesi %77.1, pozitif prediktif değeri % 58, negatif prediktif değeri %68.7 idi. Sonuç: Asetik asit sonrası vizüel inspeksiyonla tarama yönteminin (VIA), sensitivitesi ve negatif prediktif değeri smeare yakın (%56.8'e 47.3; %65.6'a 68.7), spesifitesi ve pozitif prediktif değeri anlamlı olarak yüksek (%95.4'e 77.1; %93.5'a 58) bulundu. Daha ekonomik olması da göz önüne alınarak, VIA servikal kanser taramasında smeare alternatif bir metod olarak kullanılabilir.

Anahtar Kelimeler:

Vajinal Smear, Asetik Asit, Servikal Kanser

Comparison of Visual Inspection of Cervix with Acetic Acid and Smear for Cervical Cancer Screening

Background: In this study we purposed to compare visual inspection of acetic acid (VIA) with cytology as a traditional screening program. Material and methods: Ninety five women entered to the study. They were aged 30-55. The patients has no history of hysterectomy and conisation. During speculum examination, firstly cervical smear was taken and then acetic acid (3%) was applied over the cervix. Then acetowhite area was screened with simple visual inspection. Lastly, four quadrant (12, 15, 18, 21 o'clock) biopsy was taken from all women. Biopsy results were used as a gold standart to detect correction of tests. Results: The mean age of the women was 41.06 (range 30-55), and the mean period of marriage was 20.28 (1- 42) years. Average gravity was 4.03 and parity was 2.50. 33 patient were smoking (34.73%), 38 patient (40%) had been used oral contraceptive drugs at the any part of their life. Of the 95 women examined using the VIA, 51(53.6%) were positive, and the smear was abnormal in 38 (40%) patients. And biopsi was positive in 31 (32.6%). The sensitivity of VIAwas 56.8%, the specificity was 95.4%, positive predictive value was 93.5%, negative predictive value was 65.6%. The sensitivity of smear was 47.3%, specificity was 77.1%, PPV was 58% and NPVwas 68.7%. Conclucion: The sensitivity and negative predictive value of VIA was found near to smear (56.8 %, 65.6 vs 47.3, 68.7), the specificity and positive predictive value of VIAhigher than smear (95.4 %, 93.5 vs 77.1, 58). We thought that VIAcan usable an alternative method to smear for cervical cancer screening in low resource settings.

Keywords:

Vaginal Smear, Acetic Acid, Cervical Cancer,

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