Yüksek Dereceli Lezyonların Dışlanamayacağı Atipik Skuamöz Hücrelerin Klinik Önemi; Anadolu’daki Bir Üçüncül Hastanenin Deneyimi

Çalışmamızın öncelikli amacı servikal sitolojide yüksek dereceli skuamöz lezyonların dışlanamadığı atipik skuamöz hücre (ASC-H) tanısı almış hastaların histolojik sonuçlarının değerlendirilmesi ve bu durumun klinik öneminin ortaya çıkarılmasıdır. Yirmibin yüzaltmışüç hastanın smear sonuçları değerlendirildi. Yetmiş altı (0.376 %) hastada ASC-H tanısı kondu. ASCH tanısı konan hastaların dosyaları retrospektif olarak gözden geçirildi. ASCH tanısı konan tüm hastalara kolposkopik muayene işlemi yapıldı. Kolposkopik muayenede gerekli görülen hastalara eksizyonel işlemler ile servikal ve endoservikal biyopsi işlemleri uygulandı. Hastaların klinik patolojik bilgileri dosyalarından incelenip toplandı. Gözden geçirilen 20163 smear sonucunda 1188 (5.8%) hastada servikal anormal sitoloji tespit edildi. Bu anormal servikal sitolojilerin 76 tanesinde ASCH (0.37% ) tespit edildi. ASCH tanısı alan 76 hastanın 36 (47.3%) tanesinde anormal servikal displazi tespit edildi. Bunlarında 20 (20/76-26.3%) tanesinde yüksek dereceli servikal intraepitelyal neoplazi (CIN2-3) ,12 (12/76-15.7%) tanesinde düşük dereceli servikal intraepitelyal neoplazi(CIN1) ve 4 (4 /76-5%) tanesinde servikal invazif kanser tespit edildi. ASCH tanısı önemli oranda prekanseröz ve kanseröz lezyonlarla ilişkilidir. Bu nedenle ASCH hastalarının yönetiminde ileri değerlendirme yapılırken gerekli özen ve dikkat sağlanmalıdır.

Anahtar Kelimeler:

ASCH, Servikal sitoloji, Servikal intraepitelyal neoplazi

Clinical Significance of Atypical Squamous Cells in Which High Grade Lesions Cannot Be Excluded; Experience of aTertiary Hospital in Anatolia

The primary aim of our study was to evaluate the histological results of patients diagnosed with atypical squamous cells, cannot exclude high-grade lesion (ASC-H) by cervical cytology and to reveal the clinical importance of ASC-H.Twenty thousand one hundred sixty three cervicovaginal smears were evaluated. Seventy six (0.376 %) patients were diagnosed as ASC-H. Files of patients diagnosed with ASC-H were retrospectively reviewed. We referred patients who were diagnosed as ASC-H according to the Bethesda classification system after cervicovaginal smear for colposcopic examination. İf it is necessary, cervical biopsy, endocervical and endometrial curettage were performed by the colposcopy guide. Clinicopathological features of the patients were examined and recorded. Smear results of 20163 patients reviewed. Abnormal cytological results were found in 1188 (5.8%) patients. The abnormal cytological results were ASC-H in 76 (0.37% ) patients. Abnormal cervical dysplasia was detected in 36 (47.3%) of 76 patients diagnosed as ASC-H. Twenty (20/76-26.3%) of these abnormal lesions were high-grade cervical intraepithelial neoplasia (CIN2 / 3), 12 (12/76-15.7%) of them were low-grade cervical intraepithelial neoplasia (CIN 1) and 4 (4 /76-5%) of them were cervical carcinoma. ASC-H is a diagnosis with significant association with precancerous and cancerous lesions. Therefore, further evaluation of ASC-H patients should be performed with the necessary care and attention

Keywords:

ASC-H, Cervical cytology, Cervical intraepithelial neoplasia,

PDF

___

References1. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2019. CA Cancer J Clin. 2019; 69:7-34.2. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global Cancer Statistics, 2012. CA Cancer J Clin. 2015; 65:87-108.3. The 1988 Bethesda System for Reporting Cervical/Vaginal Cytological Diagnoses. National Cancer Institute Workshop. JAMA. 1989; 262:931-934.4. Broder S. From the National Institutes of Health. JAMA. 1992; 267:1892.5. Solomon D, Davey D, Kurman R, et al. The 2001 Bethesda System: Terminology for Reporting Results of Cervical Cytology. JAMA 2002; 287:2114-9.6. Nayar R, Wilbur DC. The Pap Test and Bethesda 2014: "The Reports of My Demise Have Been Greatly Exaggerated. (After a Quotation from Mark Twain)". J Low Genit Tract Dis 2015; 19:175-84.7. Katki HA, Schiffman M, Castle PE, et al. Five-year Risks of CIN 3+ and Cervical Cancer Among Women with HPV Testing of ASC-US Pap Results. J Low Genit Tract Dis 2013;17:S36.8. Demirtas GS, Akman L, Demirtas O, et al. Clinical Significance of ASCUS and ASC-H Cytological Abnormalities: A Six-year Experience at a Single Center. Eur J Gynaecol Oncol. 2015; 36:150.9. Arco CD, Montoro CS, López DG, Escudero ER. Clinical Relevance of ASC-H Cytologies: Experience in a Single Tertiary Hospital. Acta Cytologica. 2016; 60:217–22410. Gilani SM, Tashjian R, Fathallah L. Cervical Cytology with A Diagnosis of Atypical Squamous Cells, Cannot Exclude High-grade Squamous İntraepithelial Lesion (ASC-H): A Follow-up Study with Corresponding Histology and Significance of Predicting Dysplasia by Human Papillomavirus (HPV) DNA Testing. Arch Gynecol Obstet. 2014; 289:645–64811. Tokmak A, Guzel Aİ, Ozgu E, Oz M. Clinical Significance of Atypical Squamous Cells of Undetermined Significance in Detecting Preinvasive Cervical Lesions in Post Menopausal Turkish Women. Asian Pac J Cancer Prev. 2014;15:6639-664112. Kim SH, Lee JM, Yun GH, Park US. Overall Accuracy of Cervical Cytology and Clinicopathological Significance of LSIL Cells in ASC-H Cytology. Cytopathology 2017; 28:16–2313. Arslan E, Gokdagli F, Bozdag H, Vatansever D. Abnormal Pap Smear Frequency and Comparison of Repeat Cytological Follow-up with Colposcopy During Patient Management: The İmportance of Pathologist’s Guidance in the Management. North Clin Istanb. 2019;6(1):69-7414. Nogara PRB, Manfroni LAR, Consolaro MEL. Cervical Cytology of Atypical Squamous Cells Cannot Exclude High-grade Squamous İntraepithelial Lesion (ASC-H): Histological Results and Recurrence After a Loop Electrosurgical Excision Procedure. Arch Gynecol Obstet. 2011; 284: 965–971.15. You K, Guo Y, Gen L, Qiao J. The Risk of CIN II or Greater in a One-year Follow-up Period in Patients with ASC-H İnterpreted with Cytology. Eur J Obstet Gynecol Reprod Biol. 2010; 149: 215–217.16. Gupta S, Sodhani P. Reducing ‘Atypical Squamous Cells’ Overdiagnosis Cervicovaginal Smears by Diligent Cytology Screening. Diagn Cytopathol. 2012; 40: 764–769.17. Bonvicino A, Huitron S, Fadare O. Papanicolaou Test İnterpretations of ‘Atypical Squamous Cells, Cannot Exclude High-grade Squamous İntraepithelial Lesion’ : An İnvestigation of Requisite Duration and Number of Colposcopic Procedures to a Definitive Diagnosis of High-grade Dysplasia in Routine Practice. Cancer. 2007; 111: 477–481.18. Cytryn A, Russomano FB, Camargo MJ, Zardo LMG, Horta NMSR, Fonseca Rde C, et al. Prevalence of Cervical İntraepithelial Neoplasia Grades II/III and Cervical Cancer in Patients with Cytological Diagnosis of Atypical Squamous Cells When High-grade İntraepithelial Lesions (ASC-H) Cannot beRruled Out. Sã o Paulo Med J 2009; 127: 283–287.19. Kietpeerakool C, Srisomboon J, Tantipalakorn C, Suprasert P, Khunamornpong S, Nimmanhaeminda K, et al. Underlying Pathology of Women with ‘Atypical Squamous Cells, Cannot Exclude High-grade Squamous İntraepithelial Lesion’ Smears, in a Region with a High İncidence of Cervical Cancer. J Obstet Gynaecol Res 2008; 34: 204–209.20. López-Alegría F, De Lorenzi DS, Quezada OP. Follow-up of Women with Atypical Squamous Cells Cannot Exclude High-grade Squamous İntraepithelial Lesions (ASC-H). Sã o Paulo Med J 2014; 132: 15–22.21. Selvaggi SM. Clinical Significance of Atypical Squamous Cells Cannot Exclude High Grade Squamous İntraepithelial Lesion with Histologic Correlation: A 9-year Experience. Diagn Cytopathol. 2013; 41: 943–946.22. Ayhan A, Dursun P, Kuşçu E, Mülayim B. Prevalence of Cervical Cytological Abnormalities in Turkey. Turkish Cervical Cancer And Cervical Cytology Research Group. Int J Gynaecol Obstet. 2009 ;106(3):206-923. Committee on Practice Bulletins—Gynecology. Practice Bulletin No. 168: Cervical Cancer Screening and Prevention. Obstet Gynecol. 2016; 128:e111. Reaffirmed 2018.24. Mokhtar GA, Delatour NLDR, Assiri AH, Gilliatt MA, Senterman M, Islam S: Atypical Squamous Cells, Cannot Exclude High-grade Squamous İntraepithelial Lesion: Cytohistologic Correlation Study with Diagnostic Pitfalls. Acta Cytol. 2008; 52: 169–177.25. McHale MT, Souther J, Elkas JC, Monk BJ, Harrison TA. Is Atypical Squamous Cells That Cannot Exclude High-grade Squamous İntraepithelial Lesion Clinically Significant?. J Low Genit Tract Dis. 2007; 11:86–8926. Ozlem A, Umit I. Comparative Analysis of Cervical Cytology Screening Methods and Staining Protocols for Detection Rate and Accurate İnterpretation of ASC-H: Data From a High-volume Laboratory in Turkey. Diagn Cytopathol. 2015; 43: 863–869.27. Patton AL, Duncan L, Bloom L, Phaneuf G, Zafar N. Atypical Squamous Cells, Cannot Exclude a High-grade İntraepithelial Lesion and Its Clinical Significance in Postmenopausal, Pregnant, Postpartum, and Contraceptive-use Patients. Cancer. 2008; 114:481–48828. Wright TC Jr, Cox JT, Massad LS, Twiggs LB, Wilkinson EJ. Consensus Guidelines for the Management of Women with Cervical Cytological Abnormalities. JAMA 2002;287:2120–2129.