Murat ARI, Fürüzan KAÇAR DÖĞER, SEVİN KIRDAR, HASAN YÜKSEL

Servikal Biyopsi, Smear Değerlendirmesi ve İnsan Papilloma Virüsü Alt Tiplendirme Sonuçlarının Karşılaştırılması

Amaç: Bu çalışmada, polimeraz zincir reaksiyonu (PZR) yöntemi ve doku immünhistokimyasal yöntemi ile çalışılan insan (human) papilloma virüsü (HPV) tipleri ile sitoloji ve biyopsi sonuçları arasındaki ilişkiyi tanımlamak amaçlanmıştır.Gereç ve Yöntemler: 2010-2014 tarihleri arasında hastaneye gelen 100 olgu ile çalışma yapılmıştır. PZR ile Lineer Array HPV genotiplendirme testi, doku biyopsisinin ışık mikroskopu ile değerlendirmesinin yanı sıra immünohistokimyasal yöntemle HPV tespiti ve konvansiyonel smear preparatlarının Bethesda'ya göre değerlendirmesi yapılarak sonuçlar karşılaştırılmıştır.Bulgular: Olguların 61 tanesinde yüksek riskli HPV (%61), 39 tanesinde düşük riskli HPV (%39) tespit edilmiştir. Yüksek riskli HPV tiplerinden HPV16; 24 olguda, HPV6; 19 olguda, HPV11; 9 olguda, HPV18; 7 olguda, HPV31; 2 olguda tespit edilmiştir. Düşük riskli HPV tiplerinden HPV66 (7 olgu) en sık izlenen tipti. Yirmi dört tane HPV16'lı olgunun 14'ünde epitelyal hücre anomalisi görülmüştür (%58) (9 ASCUS, 3 LSIL, 1 ASC-H, 1 AGUS), 10'u İLMAN'dı (%42). Sitolojik tanı sonuçları ile HPV tipleri arasında ki-kare testine göre anlamlı bir ilişki vardır (p=0,001). Biyopsi doku sonuçlarına bakıldığında ise 38 olguda intraepitelyal neoplazi ve malign tanısı konulurken, 62 olguda enflamasyon ve diğer benign özellikli tanılar konulmuştur. Doku tanısı ile HPV tipleri arasındaki ilişki ki-kare testine göre anlamlıdır (p

Cervical Biopsy, Smear Evaluation and Comparison of Human Papilloma Virus Subtypes Result

Objective: The aim of this study was to investigate the relationship between human papilloma virüs (HPV) types which was worked with polymerase chain reaction (PCR) and immunohistochemistry methods and cvtology and biyopsy results.Materials and Methods: A total of 100 cases from hospital between 2010-2013 participitated in this study. Linear Array HPV genotyping test was worked with PCR, tissue biopsies was evaluated with light microscopy, HPV was detected with immunohistochemistry (IHK) method and results were compared evaluating of conventional smear preparations according to Bethesda.Results: While 61 cases included high risk (61%), 39 cases included low risk HPV (39%). HPV types with high risk such as HPV16, HPV6, HPV11, HPV18, HPV31 respectively detected in 24, 19, 9, 7, 2 cases. HPV types with low risk such as HPV66 detected in 7 cases. HPV16 was observed epithelial cell abnormality such as 9 ASCUS, 3 LSIL,1 ASC-H, 1 AGUS in 14/24 ratio (58%) and ILMAN was observed 10/24 ratio (42%). Between cytological diagnosis results and HPV types are significant relationship according to chi-square test (p=0.001). When the results of the biopsy tissue analyzed, 38 patients were diagnosed intraepithelial neoplasia and malignant, 62 cases were diagnosed inflammation and other benign featured. The relationship between tissue diagnosis and HPV types is significant according to chi-square test (p<0.001). HPV in tissue was positive in 44 cases. The relationship between HPV types and tissue HPV results are significant (p<0.001). The cytological tissue diagnosis of 19 patients with ASCUS has been reported as follows; 10 CIN1, 3 CIN2, 2 CIN3 and 4 inflammation. Negative and positive HPV results studied in tissue are not significant results with cytological diagnosis (p=0.02) and tissue diagnosis results (p=0.02).Conclusion: The important of HPV detection is obvious, but tissue changes as well as HPV detection are important. Thus combined use of testing, even in evaluation with the biopsy results may give more realistic results for all types of cancers worldwide.

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Armstrong EP. "Prophylaxis of Cervical Cancer and Related Cervical Disease: A Review of the Cost-Effectiveness of Vaccination Against Oncogenic HPV Types. J Manag Care Pharm 2010; 16: 217-30.
http://kanser.gov.tr/kanser/kanser-turleri/56-serviks-kanseri. html
GLOBOCAN 2002 database: Summary table by cancer. Archived from the original on 2008-06-16. Retrieved 2008;10-26.
Stanley M. Immunobiology of HPV and HPV vaccines. 2008.
Simonetti AC, Melo JH, de Souza PR, Bruneska D, de Lima Filho JL. Immunological's host profile for HPV and Chlamydiatrachomatis, a cervical cancer cofactor. Microbes Infect 2009; 11: 435-42.
Yetimalar H, Köksal A, İnceoğlu M, Kasap B. Premalign ve Malign Lezyonlu Hastalarda HPV Enfeksiyonu. J Turk Soc Obstet Gynecol 2009; 6: 273-8.
Taşkın L. http://www.huksam.hacettepe.edu.tr/Turkce/Sayfa Dosya/Human_Pap.pdf (Erişim Tarihi: 30.05.2015).
Kjaer SK, van den Brule AJ, Paull G, Svare EI, Sherman ME, Thomsen BL, et al. Type specificpersistence of high risk human papilloma virus (HPV) as indicatorof high grade cervical squamous intraepithelial lesions in young women: Population based prospective follow up study. BMJ 2002; 325: 572.
Smith JS, Lindsay L, Hoots B, Keys J, Franceschi S, Winer R, et al. Human papillomavirus type distribution ininvasive cervical cancer and high-grade cervical lesions: A meta-analysis update. Int J Cancer 2007; 121: 621-32.
Khan MJ, Castle PE, Lorincz AT, Wacholder S, Sherman M, Scott DR, et al. The elevated 10-year risk of cervical precancer and cancer in women with human papilloma virus (HPV) type 16 or 18 and the possible utility of type-specific HPV testing in clinical practice. J Natl Cancer Inst 2005; 97: 1072-9.
Marur S, D'Souza G, Westra WH, Forastiere AA. HPV-associated head and neck cancer: A virus-related cancer epidemic. Lancet Oncol 2010; 11: 781-9.
Smith EM, Ritchie JM, Summersgill KF, Klussmann JP, Lee JH, Wang D, et al. Age, sexual behavior and human papilloma virus infection in oral cavity and oropharyngeal cancers. Int J Cancer 2004; 108: 766-72.
Anaya-Saavedra G, Ramírez-Amador V, Irigoyen-Camacho ME, García-Cuellar CM, Guido-Jimenez M, Mendez-Martinez R, et al. High association of human papillomavirus infection with oral cancer: A case-control study. Arch Med Res 2008; 39: 189-97.
Kumar, Cotran, Robins. Basic Pathology-Temel Patoloji. Çeviri Editörü: Prof. Dr. Uğur ÇEVİKBAŞ. 6. Baskı 2000.
Schiffman M, Wentzensen N. Issues in optimising and standardising the accuracy and utility of the colposcopic examination in the HPV era. Ecancermedicalscience 2015; 9: 530.
Unal B, Sezer C. Analysis of high risk hpv subtypes associated with cervical intraepithelial neoplasia: Asingle centre retrospective study in the mediterranean region of Turkey. Turk Patoloji Derg 2014; 30: 85-6.
Yavuzer D, Karadayı N, Erdağı A, Salepçi T, Baloğlu H, Dabak R. Serviks kanseri ve prekanseröz lezyonlarında PCR ile HPV tiplemesi. Kartal EAH Tıp Dergisi. 2009; 20: 1-6.
Milutin-Gasperov N, Sabol I, Halec G, Matovina M, Grce M. Retrospective study of the prevalence of high-risk human papillomaviruses among Croatian women. Coll Antropol 2007; 31 Suppl 2: 89-96.
Zhao C, Li Z, Nayar R, Levi AW, Winkler BA, Moriarty AT, et al. Prior high-risk human papillomavirus testing and Papanicolaou test results of 70 invasive cervical carcinomas diagnosed in 2012: results of a retrospective multicenter study. Arch Pathol Lab Med 2015; 139: 184-8.
Zhao C, Li Z, Austin RM. Cervical screening test results associated with 265 histopathologic diagnoses of cervical glandular neoplasia. Am J Clin Pathol 2013; 140: 47-54.
Li Z, Austin RM, Guo M, Zhao C. Screening test results associated with cancer diagnoses in 287 women with cervical squamous cell carcinoma. Arch Pathol Lab Med 2012; 136: 1533-40.
Austin RM, Zhao C. Type 1 and type 2 cervical carcinomas: Some cervical cancers are more difficult to prevent with screening. Cytopathol 2012; 23: 6-12.
Schiffman M, Wentzensen N. Issues in optimising and standardising the acuracy and utility of the colposcopic examination in the HPV era. Ecancermedicalscience 2015; 9: 530.
Mufti ST, Altaf FJ. Changing pattern of epithelial cell abnormalities using revised Bethesda system. Iran J Basic Med Sci 2014; 17: 779-84.