Aykut TUNCER, Ali AYHAN

ASC-H (YÜKSEK DERECELİ LEZYONUN DIŞLANAMADIĞI ATİPİK HÜCRE) SİTOLOJİ SONUÇLARININ HİSTOLOJİK OLARAK DEĞERLENDİRİLMESİ

Amaç: Servikal sitolojisinde yüksek dereceli squamöz intraepitelial lezyon dışlanamayan atipik skuamöz hücreler (ASC-H) saptanan hastalarda histolojide servikal intraepitelial lezyon grade ≥2 (≥ CIN 2) tanısının belirleyicilerini ortaya koymaktır. Material ve Metod: 2007- 2015 yıllarında servikal sitoloji sonucu ASC-H olup kolposkopi ile değerlendirilen olgular çalışmaya dahil edildi. Hastaların yaşı, paritesi, menapoz durumu, medeni hali, sigara kullanımı, yüksek riskli human papilloma virüs taşıyıcılığı (hrHPV) ileri doğru regresyon methodu ile analiz edildi. Anlamlılık p <0.05 değerinde hesaplandı. Bulgular: Sitoloji sonucu ASC-H olan 93 hastaya kolposkopik biyopsi yapıldı ve çalışma kapsamında değerlendirildi. Hastaların ortalama yaşı 39.37±1.03 (20-63) olup 32 hasta (% 36.8) sigara kullanmaktaydı. HPV testi 30 hastada yapılmıştı ve 10 hastada (% 33.3) hrHPV tespit edildi. Kolposkopik histoloji tanısı sonucu 44 (% 47.3) hastada normal, 10 (% 10.8), hastada CIN 1, 24 (% 25.8) hastada CIN 2, 12 (% 12.9) hastada CIN 3, 3 hastada da (% 3.2) serviks kanseri tespit edildi. ≥ CIN 2 saptanan hastaların ortalama yaşı (41.13±10.45), ≤ CIN 1 saptanan hastaların ortalama yaşı (36.92±8.61)’ndan yüksekti (p=0.042). HrHPV (+) olan 10 hastadan 9’unda (% 90), buna karşın hrHPV (-) olan 20 hastadan 2’sinde (% 10) ≥ CIN 2 lezyonu olup (p <0.001), sigara kullanan 32 hastadan 18’inde (% 56.2), buna karşın sigara kullanmayan 55 hastadan 18’inde (% 32.7) ≥CIN 2 lezyon tespit edildi (p <0.03). Regresyon analiz sonucucuna göre tek belirleyici (+) hrHPV test olarak bulundu [vs. (-) hrHPVtest; OR 6.351; 95% CI 3.673–8.947, p=0.014]. Sonuç: HPV + olan ASC-H sitolojisine sahip kadınlarda ≥ CIN 2 lezyon riski yüksek olduğundan kolposkopik muayene, biyopsi ve patolojik değerlendirme dikkatli yapılmalıdır

Anahtar Kelimeler:

HPV, serviks kanseri, kolposkopi, ASC-H

HISTOLOGIC EVALUATION OF ATYPICAL SQUAMOUS CELLS-CANNOT EXCLUDE HIGH-GRADE SQUAMOUS INTRAEPITHELIAL LESION (ASC-H) CYTOLOGY

Aim: To estimate predictors for histological diagnosis of cervical intraepithelial neoplasia of grade ≥2 (≥CIN 2) in patients with atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H) on cervical cytology. Materials and Methods: We retrospectively reviewed the patients with ASC-H who had undergone colposcopic biopsy between the years 2007-2015. Age, parity, menapousal status, marriage status, smoking habitus, high risk Human Papilloma Virus (hrHPV) status were analized with forward likelihood ratio method and significance was set at p <0.05. Results: 93 patients with ASC-H were undergone colposcopy-guided bioopsy. Mean age of the patients was 39.37±1.03 (20-63). HPV test was performed to 30 patients and 10 (33.3 % ) were HR-HPV positive (+). Histologic diagnosis were reported as normal in 44 (47.3 % ), CIN 1 in 10 (10.8 % ), CIN 2 in 24 (25.8 % ), CIN 3 in 12 (12.9 % ) and cervical cancer in 3 (3.2 % ) patients. Mean age of ≥ CIN 2 patients were 41.13±10.45 compared with 36.92±8.61 for ≤ CIN 1 patients (p=0.042). 9 of 10 (90 % ) HR-HPV (+) patients and 18 of 32 (56.2 % ) smokers had ≥ CIN 2 lesions whereas two of 20 (10 % ) HR-HPV negative (-) patients and 18 of 55 (32.7 % ) non-smokers had ≥ CIN 2 lesions (p values were, <0.001 and 0.03 for HR-HPV and smoking status, respectively). According to regression analysis (+) HR-HPV test was the only predictor [vs. (-) HR-HPVtest; OR 6.351; 95% CI 3.673–8.947, p=0.014]. Conclusion: Colposcopic evaluation, biopsy and histological diagnosis should be performed carefully for ASC-H patients, especially if they are HR-HPV positive.

Keywords:

HPV, cervical cancer, colposcopy, ASC-H.,

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ISSN: 2148-5372
Başlangıç: 2014
Yayıncı: Türk Jinekolojik Onkoloji Derneği

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