Yüksek riskli human papilloma virüs saptanan hastaların histopatolojik sonuçları

Amaç: Çalışmamızda Çorum ili sağlık müdürlüğü tarafından 2016-2017 yılları arasında Ulusal HPV tarama programı kapsamında Çorum ili genelinde HPV DNA taraması yapılan ve pozitiflik saptanması nedeni ile hastanemizde kolposkopik biyopsi işlemi yapılan hastaların histopatolojik sonuçları ile HPV subtiplerinin karşılaştırılması amaçlanmıştır. Yöntem: Çalışmaya HPV DNA pozitifliği nedeni ile kolposkopik biyopsi işlemi yapılan 30-65 yaş arasındaki kadınların tamamı dahil edildi. HPV tipleri tip 16, 18 ve diğerleri olarak üç kategoriye ayrıldı. Kolposkopik biyopsi materyallerine ait patoloji sonuçları normal / düşük dereceli skuamöz intraepitelyal lezyon LSIL ve yüksek dereceli skuamöz intraepitel lezyon HSIL olarak kategorize edildi. Bulgular: 212 hastaya HPV DNA pozitifliği saptanması nedeni ile kolposkopi eşliğinde servikal biyopsi yapıldı. HPV tiplerine göre bu sayı dağıtıldığında HPV tip 16,18 ve diğerlerinde sırası ile 126, 13 ve 73 olarak dağılmaktaydı. Kolposkopi sonucunda 63 hastada %30 LSIL, 56 hastada %26 HSIL saptanırken 93 hastada %44 displazi saptanmadı. HPV tiplerine göre bu sayı dağıtıldığında ise HPV tip 16, 18 ve diğerlerinde LSIL sırası ile 32 %28 , 3 %24 , 20 %28 iken, HSIL sırası ile 39 %31 , 6 %46 , 11 %15 saptandı. LSIL ve HSIL ayrımı yapmaksızın displazi saptanma yüzdeleri HPV tip 16,18 ve diğerlerinde sırası ile 79 %62.6 , 9 %69.2 , 31 %42 olarak saptandı. Hastalar yaş aralığına göre dağıtıldığında displazi saptanma yüzdesinin yaş ile beraber arttığı ve 60-65 yaş aralığında % 68 e ulaştığı görüldü. Sonuç: HPV 16 ve 18 pozitif saptanan hastaların kolposkopik biyopsilerinde displazi saptanma riski diğer subtiplere oranla daha yüksek olduğundan bu hastaların mutlaka kolposkopik biyopsi ile değerlendirilmesi gereklidir. HPV DNA insidansı toplumda yaş ilerledikçe azalmaktadır ancak özellikle 5. ve 6. dekatta HPV pozitifliği saptanması durumunda bu hastalara ivedilikle kolposkopi işlemi yapılmalıdır çünkü yaş ilerledikçe displazi saptanma yüzdesi artmaktadır.

Anahtar Kelimeler:

HPV, serviks, kolposkopik biyopsi, displazi

Histopathological results of high risk HPV DNA detected patients

Objective: In our study, it was aimed to compare histopathologic results and HPV subtypes of the patients who were performed colposcopy because of detected HPV DNA positivity in National HPV Screening Program between 2016-2017 years in Çorum province. Methods: All women aged 30-65 years who performed colposcopic biopsy cause of HPV DNA positivity were included in the study. HPV types were divided into three categories as types 16, 18 and others. Pathology results of colposcopic biopsy materials were categorized as Normal, Low grade squamous intraepithelial lesion CIN I and high grade squamous intraepithelial lesion CIN II/III . Results: A total of 212 patients detected HPV DNA positivity, were performed cervical biopsy accompanied by colposcopy. When distributed according to HPV types; HPV types 16, 18 and others were found to be positive in 126, 13 and 73 individuals, respectively. As a result of colposcopy, HSIL were detected in 63 patients 29% , LSIL were detected in 56 patients 26% and no dysplasia was detected in 93 patients 44% . LSIL were detected in 32 28% patients with HPV 16, in 3 24% patients with HPV 18 and in 20 28% patients with other types. HSIL were detected in 39 31% patients with HPV 16, in 6 46% patients with HPV 18 and in 11 15% patients with other subtypes. The percentages of dysplasia HSIL + LSIL were found 79 62,6% in HPV 16, 9 69.2% in HPV 18 and 31 42% in other subtypes. Patients were evaluated according to age range. A positive correlation between the detection rate of dysplasia and age was observed and it was observed that this ratio reached to 68% in the age range of 60-65 years. Conclusion: The probability of detecting dysplasia in colposcopic biopsies of patients with positive HPV 16 and 18 are higher than other subtypes. Therefore, these patients have to be absolutely evaluated with colposcopic biopsy. The incidence of HPV DNA decreases with age. However, colposcopy have to be performed immediately when HPV positivity is detected especially in the 5th and 6th decades because the percentage of dysplasia detection increases with age.

Keywords:

HPV, Cervix, colposcopic biopsy, dysplasia,

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