Mohammad İbrahim HALİLZADE, İnci HALİLZADE, Fulya KAYIKÇIOĞLU, Sevgi KOÇ

HPV Pozitif Kadınlarda ASC-US ve LSIL Sitolojilerinin Klinik Veri ve Kolposkopi Sonuçlarının Karşılaştırılması

ÖZET Amaç: Çalışmamızın amacı, yüksek riskli insan papilloma virüs (hrHPV) pozitif kadınlar arasında önemi belirsiz atipik skuamöz hücre (ASC-US) ve düşük dereceli skuamöz intraepitelyal lezyon (LSIL) sitolojisinin klinik verileri ile kolposkopiye yönelik biyopsi (CDB) sonuçlarını karşılaştırmaktır. Gereç ve Yöntem: Çalışmaya 20-67 yaşları arasında ASC-US ve LSIL sitolojisi olan toplam 359 hrHPV pozitif hasta dahil edildi. Katılımcıların yaşı, eğitim durumu, sigara içme durumu, kolposkopi sonuçları ve CDB sayısı değerlendirildi ve klinik veriler biyopsilerin histopatolojik değerlendirmesiyle istatistiksel olarak karşılaştırıldı. Bulgular: hrHPV + ASC-US ve hrHPV + LSIL grupları arasında yaş, medeni durum, eğitim durumu ve sigara içme durumu açısından istatistiksel olarak anlamlı fark yoktu. Her iki grup CDB'lerin histopatolojik sonuçları açısından karşılaştırıldı ve gruplar arasında istatistiksel olarak anlamlı bir fark gözlenmedi. CDB materyali sayısı ve endoservikal küretaj sıklığı hrHPV + LSIL'de hrHPV + ASC-US hastalarına göre anlamlı olarak daha yüksekti. İleri tedavi ihtiyacı açısından iki grup arasında istatistiksel olarak anlamlı fark yoktu. Hem ASC-US hem de LSIL gruplarının takibi sırasında gerçekleştirilen kontrol sitolojisi benign olarak sonuçlandı. Sonuç: HPV pozitifliğinde ASCUS ve LSIL'e yaklaşım benzer şekilde önemlidir. Takip süremiz 1 yıllık bir süreyi içerdiğinden, daha uzun vadeli sonuçların gösterilebilmesi için daha ileri çalışmaların yapılması gerekmektedir.

Anahtar Kelimeler:

ASCUS, LSIL, KOLPOSKOPİ, HPV

Comparison of Clinical Data and Colposcopy Results of HPV-positive Women with ASC-US and LSIL

ABSTRACT Objective: The aim of our study is to compare the clinical data and colposcopy- directed biopsy (CDB) results of atypical squamous cell of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL) cytology among high risk human papilloma virus (hrHPV) positive women. Materials and Methods: A total of 359 hrHPV-positive patients with ASC-US and LSIL cytology, between 20-67 years of age were included in the study. Participants’ age, education status, smoking status, colposcopy results, and number of CDBs were assessed and clinical data compared with histopathologic evaluation of biopsies statistically. Results: There were no statistically significant differences in terms of age, marital status, education status and smoking status of hrHPV + ASC-US and hrHPV + LSIL groups. Both groups were compared in terms of histopathologic results of CDBs and no statistically significant difference was observed between the groups. The number of CDB material and frequency of endocervical curettage were significantly higher in hrHPV + LSIL than hrHPV + ASC-US patients. There was no statistically significant difference between the two groups in terms of advanced treatment need. Control cytology performed during follow-up of both ASC-US and LSIL groups were resulted as benign. Conclusion: The approach to ASCUS and LSIL is similarly important in HPV positivity. Since our follow up period includes a sort period of 1 year, further studies need to be carried out in order to demonstrate longer term outcomes.

Keywords:

ASCUS, LSIL, COLPOSCOPY, HPV,

PDF

___

1. Schiffman M, Castle PE, Jeronimo J, Rodriguez AC, Wacholder S. Human papillomavirus and cervical cancer. Lancet. 2007 Sep 8;370(9590):890-907.
2. Wright TC Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D; 2006 American Society for Colposcopy and Cervical Pathology-sponsored Consensus Conference. 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gynecol. 2007 Oct;197(4):346-55.
3. The Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesions Triage Study (ALTS) Group. Human papillomavirus testing for triage of women with cytologic evidence of low-grade squamous intraepithelial lesions: baseline data from a randomized trial. J Natl Cancer Inst 2000;92:397–402.
4. Schiffman M, Solomon D. Findings to date from the ASCUS-LSIL triage study (ALTS). Arch Pathol Lab Med 2003;127:946-9.
5. Saslow D, Runowicz CD, Solomon D, Moscicki AB, Smith RA, Eyre HJ et al. American Cancer Society. American Cancer Society guideline for the early detection of cervical neoplasia and cancer. CA Cancer J Clin. 2002;52:342-62.
6. Demirel G, Gölbaşı Z. Current status in women's health screening. Gümüşhane University Journal of Health Sciences 2015;4:638–59.
7. Cuzick J, Beverley E, Ho L, Terry G, Sapper H, Mielzynska I et al. HPV testing in primary screening of older women. Br J Cancer. 1999;81:554-8.
8. Blumenthal PD, Gaffikin L, Chirenje ZM, McGrath J, Womack S, Shah K. Adjunctive testing for cervical cancer in low resource settings with visual inspection, HPV, and the Pap smear. Int J Gynaecol Obstet. 2001;72:47-53.
9. Clavel C, Masure M, Bory JP, Putaud I, Mangeonjean C, Lorenzato M et al. Human papillomavirus testing in primary screening for the detection of high-grade cervical lesions: a study of 7932 women. Br J Cancer. 2001;84:1616-23.
10. Fang J. Cervical Cancers and Malignancies of Pelvis. Serviks Kanserleri,Pelvis Maligniteleri. In: Beck WW(ed). National Medical Series For İndependent Study (NMS), Kadın Hastalıkları ve Doğum. 4.nd ed. Ankara:Nobel, 1998: (36);409-413.
11. Cuzick J, Szarewski A, Cubie H, Hulman G, Kitchener H, Luesley D et al. Management of women who test positive for high-risk types of human papillomavirus: the HART study. Lancet 2003;362:1871-6.
12. Gultekin M, Zayifoglu Karaca M, Kucukyildiz I, Dundar S, Boztas G, Semra Turan H. Initial results of population based cervical cancer screening program using HPV testing in one million Turkish women. Int J Cancer. 2018 May 1; 142(9): 1952–1958.
13. Cox JT, Schiffman M, Solomon D. Prospective follow-up suggests similar risk of subsequent cervical intraepithelial neoplasia grade 2 or 3 among women with cervical intraepithelial neoplasia grade 1 or negative colposcopy and directed biopsy.; ASCUS-LSIL Triage Study (ALTS) Group. Am J Obstet Gynecol. 2003;188:1406-12.
14. Siebers AG, van der Linden H, Vedder JEM, Bekkers RLM, Melchers WLG, Bulten J. Presence of koilocytosis in low-grade smears of high-risk HPV-positive women is a negative predictor for cervical intraepithelial neoplasia grade 3 or more. Cytopathology. 2018;29(3):275-80.
15. 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 Jun; 54(3) : 263-9.
16. Wright TC, Stoler MH, Parvu V, Yanson K, Cooper C, Andrews J. Risk detection for high-grade cervical disease using Onclarity HPV extended genotyping in women, 21years of age, with ASC-US or LSIL cytology. Gynecol Oncol. 2019;154(2):360-7.