Ziya Cibali AÇIKGÖZ, Emre Erdem TAŞ, Aylin YAZGAN, Ayşegül GÖZALAN, Sibel AYDOĞAN, Ayşe Filiz YAVUZ

Eş zamanlı servikal sitoloji örneklerinde yüksek riskli HPV tiplerinin varlığı ve dağılımı

Amaç: Human papillomavirus, reprodüktif sistemin en sık görülen viral enfeksiyon etkenidir ve neredeyse tüm serviks kanseri olgularıyla ilişkisi gösterilmiştir. Servikal kanser tarama programları ile erken tanı ve tedavi sayesinde insidans ve mortalite oranları etkin şekilde azalmaktadır. Bu çalışmada üç yıllık bir süre içinde çalışılan HPV DNA test sonuçları ve eş zamanlı servikal sitoloji örneklerinin değerlendirilmesi amaçlanmıştır. Yöntem: 2012-2014 yılları arasında Moleküler Mikrobiyoloji Laboratuvarı’na HPV DNA araştırılması ve genotip tayini amacıyla gönderilen 328 hastaya ait tesrt sonuçları retrospektif olarak analiz edilmiştir. Hastaların sitoloji sonuçları eş zamanlı olarak patoloji laboratuvarı tarafından retrospektif olarak değerlendirilmiş, gerek duyulan örnekler tekrar incelenerek servikal anormallikler ile HPV varlığı ve genotipler arasındaki ilişkiler ortaya konulmuştur. Servikal örnek alımında DigeneHC2 DNA Collection Device® kullanılmış ve DNA eldesi QIAamp® DNA Mini Kit ile yapılmıştır. DNA örneklerinde yüksek riskli HPV tiplerinin varlığı Genotyping Kit HPV GP kullanılarak araştırılmıştır. Sitolojik değerlendirme konvansiyonel Papanicolau testi ile yapılmış ve sonuçlar 2001 Bethesda Sistemi’ne göre yorumlanmıştır. Bulgular: Hastaların yaş ortancası 36 olup, test sonucu pozitif ve negatif kadınların yaş ortancaları arasında anlamlı fark bulunmamıştır. Yüksek riskli HPV DNA analizi yapılan 328 hastanın 110 tanesinde (%33.5) pozitif sonuç elde edilmiş ve %22.7 oranında multiple tip varlığı bulunmuştur. En sık saptanan tipler HPV16/51/18/56 olarak belirlenmiştir. Hastaların 270’inde eş zamanlı sitolojik değerlendirme yapılmış ve %21.5 anormal sitoloji saptanmıştır. Anormal sitoloji saptanan hastaların sitolojik bulgulara göre dağılımı; %48.3 ASCUS, %34.5 LSIL, %7 ASC-H, %7 HSIL ve %3.5 AGUS şeklinde olmuştur. Anormal sitoloji saptanan hastalardaki HPV pozitifliği (%50), normal sitolojili hastalardaki HPV pozitifliğinden (%28.3) istatistiksel olarak anlamlı derecede yüksek bulunmuştur (p=0.002). Çalışmamızda Tip 16, anormal sitolojili grupta %38, normal sitolojili grupta ise %44 oranında saptanmıştır. Sonuç: Servikal kanser tarama programları tüm dünyada hızla önem kazanırken, HPV genotipleme önemli rol üstlenmektedir. Normal sitolojili hastalarda da Tip 16’nın yüksek oranda saptanması, sitolojik incelemenin mutlaka DNA çalışması ile desteklenmesi ve hastaların yakın takibe alınması gerekliliğini kanıtlamaktadır.

The presence and distribution of high risk HPV types in simultaneous cervical cytology samples

Objective: Human papillomavirus (HPV) is the mostdetected viral pathogen of reproductive system and almostall servical carsinomas are related to HPV. The incidanceand mortality rate of cervical carsinomas are significantlydecrease by means of early diagnosis and treatmentowing to servical cancer screening programmes. The aimof the study is to evaluate the results of HPV DNA testsand cervical cytology specimens simultaneously in a threeyear period.Methods: The test results of 328 patients that weresend to determine Molecular Microbiology Laboratoryfor HPV DNA and genotype between 2012-2014 wereretrospectively analysed. Moreover, the cytology results ofthe same patient group were reviewed simultaneously bypathologist and reexamined if necessary. The relationshipbetween cervical anomalies and the presence of HPV DNAand genotypes were exhibited. Cervical samples werecollected in DigeneHC2 DNA Collection Device and DNAwas isolated using QIAamp DNA Mini Kit. DNA sampleswere tested for high risk HPV infection by the GenotypingKit HPV GP. Cytological examination were done by usingconventional (Papanicolaou) method and interpretedaccording to 2001 Bethesda System.Results: The median age of the patients was found36 and there was no significant difference between themedian ages of the HPV DNA negative and positive women.High risk HPV DNA was determined 110 out of 328 patients(33.5%) and multiple types were detected 22.7% of thecases. The most determined types were HPV-16/51/18and 56 respectively. Abnormal cytology was detectedfrom 21.5% of the 270 patients that were evaluated bypathologist simultaneously. The abnormal cytologic signsof the patients were reported as 48.3% ASCUS, 34.5% LSIL,7% ASC-H, 7% HSIL and 3.5% AGUS. The HPV DNA positivityof the patients with abnormal cytologic results (50%)were found high significantly comparing the patientswith normal cytology (28.3%) (p=0.002). The type 16 wasdetermined 38% and 44% from the patients with abnormaland normal cytology, respectively.Conclusion: The genotyping of HPV plays animportant role while the cervical cancer screeningprogrammes have gaining importance globally. Thedetermination of high rates of type 16 from patients withnormal cytology proves that cytologic evaluation shouldbe supported by DNA typing and those patients should befollowed up closely.

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