SERVİKAL İNTRAEPİTELYAL LEZYONLARDA VE YÜKSEK RİSKLİ HPV TİPLERİNDE SERVİKAL KOLPOSKOPİNİN YERİ

AMAÇ: Bu çalışmada, smear sonucu düşük dereceli servikal intraepitelyal lezyon (LSIL), yüksek dereceli servikal intraepiteliyal lezyon (HSIL), önemi belirsiz tipik olmayan yassı hücreler (ASCUS) tespit edilen, servikal muayenede erzoyon saptanan hastalar ve yapılan human papilloma virüs (HPV) testi pozitif olan takiben kolposkopik biyopsi uygulanan hastalarımızda HPV, smear ve biyopsi sonuçları karşılaştırılması amaçlanmıştır.GEREÇ VE YÖNTEM: Toplamda çalışma grubu olarak 186 hasta dahil edildi. Hastalardan alınan servikal smearlar değerlendirildi. Servikal smear sonucu; ASCUS, LSIL ve HSIL, olan hastalar ile HPV pozitif hastalar kolposkopiye yönlendirildi. HPV tiplerinden 16, 18, 31 ve 33 olanları yüksek riskli, diğerlerini düşük riskli olarak gruplandırdık. Buna göre HPV, smear ve biyopsi sonuçları karşılaştırıldı.BULGULAR: Çalışmaya dahil edilen 186 hastanın 74’ü (%39,7) menopozdaydı. Kolposkopi yapılan hastaların 103’ünde (%55,3) HPV testi sonucu pozitif saptanması nedenli kolposkopi yapıldı. Bu hastaların 82’si yüksek riskli HPV grubundaydı. ASCUS nedenli 35 (%18,8) olguya, servikal erozyon nedenli 33 hastaya (%17,7), LSIL nedenli 12 hastaya (%6,5) HSIL nedenli 3 hastaya (%1,6) kolposkopi yapıldı. Kolposkopi yapılan hastaların alınan biyopsilerinin patoloji sonuçlarına bakacak olursak 134’ü (%72) benign olarak geldi. Smear sonucu malignite izlenmedi olarak gelen 121 hastanın kolposkopik biyopsi sonuçları değerlendirildiğinde 19 hastada CIN1 (%15,7), 6 hastada CIN2(%5), 2 hastada CIN3(%1,7) saptandı. Smear sonucuna göre LSIL gelen hastaların %25’inde ileri düzeyde epitelyal anomali (CIN 2 ve 3) gözlenirken, HSIL olan hastalarda bu oran %50 olarak tespit edilmiştir. HPV tipleri ile kolposkopik biyopsi sonuçları karşılaştırıldığında yüksek riskli HPV tipleri ile %37,8 oranında CIN 1, 2 ve 3 tespit edilirken, düşük riskli grupta bu oran %9,5 olarak bulunmuştur (p<0.016).SONUÇ: Smear tarama testi olarak kullanılmalıdır ve LSIL veya HSIL varlığında mutlaka kolposkopik biyopsi ile tanının doğrulanması gereklidir. Ayrıca özellikle yüksek riskli HPV tiplerinin pozitifliği tespit edilen olgularda smear sonucundan bağımsız olarak da kolposkopik biyopsinin önemi anlaşılmaktadır.

Anahtar Kelimeler:

Kolposkopi, Smear, Servikal intraepitelyal lezyon, Human papilloma virüs, Colposcopy, Cervical intraepithelial lesion, Human papilloma virus

CERVICAL INTRAEPITHELIAL LESIONS AND THE PLACE OF CERVICAL COLPOSCOPY IN HIGH RISK HPV TYPES

OBJECTIVE: In our study, patients with low-grade cervical intraepithelial lesion (LSIL), high-grade cervical intraepithelial lesion (HSIL), non-typical squamous cells (ASCUS) of indeterminate significance, and patients with eruption on cervical examination and human papilloma virus (HPV) test. We aimed to compare the results of HPV, smear and biopsy in patients who were positive followed by colposcopic biopsy.MATERIAL AND METHODS: In total, 186 patients were included as the study group. Cervical smears taken from the patients were evaluated. Patients whose cervical smear results were determined as ASCUS, LSIL and HSIL and HPV positive patients were referred for colposcopy. We grouped the HPV types 16, 18, 31 and 33 as high-risk and the others as low-risk. Accordingly, HPV, smear and biopsy results were compared.RESULTS: Of the 186 patients included in the study, 74 (39.7%) were in menopause. Colposcopy was performed due to the detection of HPV positivity in 103 (55.3%) of the patients who underwent colposcopy. 82 of these patients were in the high risk HPV group. Colposcopy was performed in 35 patients (18.8%) with ASCUS, 33 patients with cervical erosion (17.7%), 12 patients with LSIL (6.5%) and 3 patients (1.6%) with HSIL. If we look at the pathology results of the biopsies taken from the patients who underwent colposcopy, 134 of them (72%) came as benign. When the colposcopic biopsy results of 121 patients whose smear results were found to be without malignancy, 19 patients had CIN1 (15.7%), 6 patients (5%), and 2 patients CIN3 (1.7%). According to smear results, advanced epithelial anomalies (CIN 2 and 3) were observed in 25% of patients who received LSIL, while this rate was found to be 50% in patients with HSIL. When HPV types and colposcopic biopsy results were compared, CIN 1, 2 and 3 were detected as a rate of 37.8 in the high-risk HPV types , while this rate was 9.5% in the low-risk group (p <0.016).CONCLUSIONS: It was concluded that smearin is a screening test and the diagnosis should be confirmed by biopsy under colposcopy in the presence of LSIL or HSIL. In addition, the importance of colposcopic biopsy is understood, regardless of the smear result, especially in cases with positive HPV types.

Keywords:

Colposcopy, Cervical intraepithelial lesion, Human papilloma virus,

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