Ata Erdem TÜRK, Bahar Nur ŞAHİN, Deniz Gökçe YILDIZ, Ada ARAY, Berkay AKSOYAK, Zeynep Berra ŞİMŞEK, Tugba TEKELİOGLU, Hüseyin AKILLI, Esra KUŞÇU, Ali AYHAN

276280

Önemi Belirsiz Atipik Skuamöz Hücre (ASCUS) sitolojisi olan hastalarda HPV yükü ve CIN II veya daha kötü patoloji riski

Amaç:Önemi belirsiz atipik skuamöz hücre(ASCUS) sitolojisi olan hastalarda tanı anında HPV yükü ve servikal intraepitelyal lezyon grad II(CIN II) veya üstü patoloji riskini değerlendirmektir. Gereç ve Yöntem:Çalışmaya 2011-2021 yılları arasında ASCUS sitolojisi olan ve Human Papillomavirus(HPV) testi yapılan hastalar dahil edildi. HPV testi pozitif olan hastalara kolposkopik biyopsi yapıldı. Hastanın tıbbi kayıtları ve demografik bilgileri geriye dönük olarak değerlendirildi. HPV pozitiflik oranı ve CIN II veya daha kötü patoloji riski SPSS paket programı kullanılarak değerlendirildi. Bulgular: Ortanca yaş 39(22-73) idi. 749 hastaya HPV testi uygulandı, 353'ünde(%47,1) HPV pozitifti. 68 hastada HPV-16(%10,7), 44(%7) hastada HPV-52, 39(%6) hastada HPV-18 ve 32(%5,1) hastada HPV-31 pozitifti. Seksen sekiz hastada (%11.7) HPV-16 /18 ve 90(%12) hastada üçten fazla HPV tipi pozitifti. 369(%51) hastaya servikal biyopsi yapıldı ve bunların 236(%64)'sında servisit veya normal patoloji vardı.52(%14,1) hastada CIN-I, 22(%6)'de CIN-II, 57(%15,4)'de CIN-III ve 2(%0,05) hastada carcinoma in situ saptandı. HPV Tip-16 ve/veya 18'in multivaryant analizde CIN-2+ lezyonlarının varlığı riskini artırdığı bulunmuştur(OR:6,2, %95 GA: 3,3-11,9, P=0,00). HPV-16/18 testinin CIN-2 + lezyonunu saptamada duyarlılık ve özgüllüğü sırasıyla %54,7 ve %83 olarak bulundu ve aynı test için Negatif Öngörü Değeri(NPV) %89 ve Pozitif Öngörü Değeri(PPV) %56,7 idi. Sonuç: Kurumumuzda ASCUS popülasyonunda HPV pozitifliği nispeten yüksektir ve HPV-16/18'in varlığı ile CIN-II+ lezyon riski altı kat artmıştır. Ayrıca, HPV-16/18 testi, CIN-II ve üstü lezyonları tespit etmede düşük PPV ve yüksek NPV'ye sahiptir.
Anahtar Kelimeler:

Önemi Belirsiz Atipik Skuamoz Hücre (ASCUS), Human Papillomavirus(HPV), Servikal İntraepitelyal Neoplazi II plus(CIN-II+), Serviks Kanseri

HPV burden and risk of CIN II or worse pathology in patients with atypical squamous cell of undetermined significance (ASCUS) cytology

Objective:The aim of the study was to evaluate the Human Papillomavirus(HPV) burden and the risk of Cervical Intraepithelial Lesion grade II(CIN-II) or worse pathology in patients with Atypical Squamous Cell of Undetermined Significance(ASCUS) cytology at the time of diagnosis. Matherial and Methods:The study included patients who have ASCUS cytology and underwent HPV testing between the years 2011-2021.Colposcopic biopsy were performed in patients with positive HPV.The patient's medical records and demographic information were evaluated retrospectively.The proportion of HPV positivity and the risk of CIN-II or worse pathology were evaluated by using SPSS package programme. Results:Median age was 39 years(22-73y).749 patients had HPV test and 353(47.1 %) of them was HPV positive. 68(10.7 %) patients had HPV-16, 44(7%) had HPV-52, 39(6%) had HPV-18 and 32(5.1%) had HPV-31.Eighty-eigth(11.7%) patients had HPV-16/18 and 90(12 %) had more than three HPV types. 369(51%) patients underwent cervical biopsy and 236(64%) of them had cervicitis or normal pathology.52(14.1%) patients had CIN-I ,22(6%) had CIN-II, 57(15.4%) had CIN-III and 2(0.5%) had Carcinoma in Situ. HPV-16 and/or 18 was found to increase the risk of the presence of CIN-II+ lesions in multivariate analysis(OR: 6.2, 95%CI 3.3-11.9, P=0.00).Sensitivity and specifity of HPV-16/18 for detecting CIN-II+ lesion was 54.7% and 83% respectively and the Negative Predictive Value(NPV) was 89% and Positive Predictive Value(PPV) was 56.7%. Conlusion:HPV positivity in the ASCUS population is relatively high in our institution and risk of CIN-II+ lesions sixfold increased with the presence of HPV-16/18.Moreover,HPV-16/18 testing has low PPV and high NPV in detecting CIN-II plus lesions
Keywords:

Atypical Squamous Cells of Undetermined Significance (ASCUS), Human Papillomavirus(HPV), Cervical Intraepithelial Neoplasia II plus(CIN-II+), Cervical Cancer,

PDF

___

  • 1. Sung, Hyuna, et al. "Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries." CA: a cancer journal for clinicians 71.3 (2021): 209- 249.
  • 2. Kuo DY, Goldberg GL. Screening of cervical can- cer: where do we go from here? Cancer Invest. 2003;21(1):157-61.
  • 3. Musa J, Achenbach CJ, O'Dwyer LC, Evans CT, McHugh M, Hou L, et al. Effect of cervical cancer ed- ucation and provider recommendation for screen- ing on screening rates: A systematic review and meta-analysis. PLoS One. 2017;12(9):e0183924.
  • 4. McCredie MR, Sharples KJ, Paul C, Baranyai J, Medley G, Jones RW, Skegg DC. Natural history of cervical neoplasia and risk of invasive cancer in women with cervical intraepithelial neopla- sia 3: a retrospective cohort study. Lancet Oncol. 2008 May;9(5):425-34. doi: 10.1016/S1470- 2045(08)70103-7. Epub 2008 Apr 11. PMID: 18407790.
  • 5. The 1988 Bethesda System for Report- ing Cervical/Vaginal Cytological Diagno- ses. JAMA. 1989;262(7):931-934. doi:10.1001/ jama. 1989.03430070079034
  • 6. Stoler, Mark H., et al. "High-risk human papillo- mavirus testing in women with ASC-US cytology: results from the ATHENA HPV study." American journal of clinical pathology 135.3 (2011): 468- 475.
  • 7. Tao, Xiang, et al. "Atypical squamous cells of un- determined significance cervical cytology in the Chinese population: Age stratified reporting rates, high risk HPV testing, and immediate histologic correlation results." Cancer Cytopathology 129.1 (2021): 24-32.
  • 8. Turkish Cervical Cancer And Cervical Cytol- ogy Research Group. Prevalence of cervical cy- tological abnormalities in Turkey. Int J Gynaecol Obstet. 2009 Sep;106(3):206-9. doi: 10.1016/j. ijgo.2009.04.003. Epub 2009 Jun 21. PMID: 19541303.
  • 9. Gultekin, Murat, et al. "Initial results of popula- tion based cervical cancer screening program using HPV testing in one million T urkish wom- en." International journal of cancer 142.9 (2018): 1952-1958.
  • 10. Carozzi, Francesca Maria, et al. "Triage with hu- man papillomavirus testing of women with cyto- logic abnormalities prompting referral for colpos- copy assessment." Cancer Cytopathology: Inter- disciplinary International Journal of the American Cancer Society 105.1 (2005): 2-7.
  • 11. Liu, Fang, et al. "Association of human papilloma- virus genotype distribution and cervical cytology: a cross-sectional study" Epidemiology & Infec- tion 149 (2021).
  • 12. de Sanjose, Silvia, Maria Brotons, and Miguel An- gel Pavon. "The natural history of human papillo- mavirus infection." Best practice & research Clini- cal obstetrics & gynaecology 47 (2018): 2-13.
  • 13. Avcı, Gülçin Alp, and Gülendam Bozdayı. "Human papillomavirus." Kafkas Journal of Medical Scienc- es 3 (2013): 136-144
  • 14. A Phase I Study of Quadrivalent Human Papilloma Virus (HPV) (Types 6, 11, 16, 18) Recombinant Vaccine in HIV-Infected and HIV-Negative Pre- Adolescents, Adolescents and Young Adults
  • 15. Petca, Aida, et al. "Non-sexual HPV transmission and role of vaccination for a better future." Experi- mental and Therapeutic Medicine 20.6 (2020): 1-1.
  • 16. Zhang, Huina, et al. "Immediate histologic corre- lation in women with atypical squamous cells of undetermined significance cytology and positive high risk HPV: A retrospective review of 6000 cas- es in a large academic women's hospital." Cancer Cytopathology 128.11 (2020): 852-859.
  • 17. Zhou, Feng, et al. "Prevalence of genotype-specific human papillomavirus in cytology specimens and cervical biopsies, and its implication in cervical cancer risk stratification: a retrospective study of 10647 cases." Journal of Cancer 12.23 (2021): 7167.
  • 18. Bansal N, Wright JD, Cohen CJ, Herzog TJ. Natural history of established low grade cervical intraepi- thelial (CIN 1) lesions. Anticancer Res. 2008 May- Jun;28(3B):1763-6. PMID: 18630456.
  • 19. Egemen, Didem, et al. "Risk estimates supporting the 2019 ASCCP risk-based management consen- sus guidelines." Journal of lower genital tract dis- ease 24.2 (2020): 132.
  • 20. Gultekin, Murat, et al. "How to triage HPV positive cases: Results of four million females." Gynecolog- ic oncology 158.1 (2020): 105-111.
  • 21. Phianpiset, Rattiya, et al. "ASCCP Risk-Based Colposcopy Recommendations Applied in Thai Women With Atypical Squamous Cells of Unde- termined Significance or Low-Grade Squamous Intraepithelial Lesion Cytology." Obstetrics & Gy- necology 136.3 (2020): 510-517.
  • 22. Monsonego, Joseph, et al. "Prevalence of high-risk human papilloma virus genotypes and associated risk of cervical precancerous lesions in a large US screening population: data from the ATHENA trial." Gynecologic oncology 137.1 (2015): 47-54.
  • 23. Yalcin, Ibrahim, et al. "Analysis of histopathology results of ASCUS and LSIL cytology in HPV DNA positive cases." Acta Oncologica Turcica 51.3 (2018): 306-310.
  • 24. Demarco, Maria, et al. "Risks of CIN 2+, CIN 3+, and cancer by cytology and human papillomavi- rus status: the foundation of risk-based cervical screening guidelines." Journal of lower genital tract disease 21.4 (2017): 261.
  • 25. Aoki, Eiko Saitoh, et al. “Validation of HPV triage in cytology-based cervical cancer screening for ASC-US cases using Japanese data." Journal of Gy- necologic Oncology 34 (2022).
  • 26. Baena, Armando, et al. "Comparison of immedi- ate colposcopy, repeat conventional cytology and hrHPV testing for the clinical management of ASC- US cytology in routine health services of Medellin, Colombia: The ASCUS-COL Trial." International Journal of Cance
Türk Jinekolojik Onkoloji Dergisi-Cover
  • ISSN: 2148-5372
  • Başlangıç: 2014
  • Yayıncı: Türk Jinekolojik Onkoloji Derneği
Arşiv
Sayıdaki Diğer Makaleler

Yüksek Dereceli Skuamoz İntraepitelyal Lezyonu Olan Hastalarda Punch ve Loop Biyopsinin Karşılaştırılması

Varol GÜLSEREN, Kemal GÜNGÖRDÜK

Aniden ortaya çıkan nodül Sister Mary Joseph : Olgu Sunumu

Gamze SÖNMEZ ÜNAL, Neşe YELDİR, Çağlar YILDIZ, İrem KÜÇÜKYILDIZ

BORDERLINE OVER TÜMÖRLERİNDE FROZEN SECTİON İLE TANI DOĞRULUĞU

Sıtkı ÖZBİLGEÇ, Fatih AKKUŞ, Emine Türen DEMİR, Okancan YILMAZ, Pembe OLTULU, Ali ACAR

Beyin Metastazlı Jinekolojik Kökenli Malignitelerde Prognostik Faktörlerin Analizi

Tahir ERYILMAZ, Hüseyin AKILLI, Ali AYHAN, Ahmet Muhteşem AĞILDERE

Primer ve nüks jinekolojik vakalarda pelvik egzenterasyon

Tuğçe SIRMA, Yunus İLHAN, Levent AKMAN, Mustafa Coşan TEREK, Ahmet Aydın ÖZSARAN, Nuri YILDIRIM

Önemi Belirsiz Atipik Skuamöz Hücre (ASCUS) sitolojisi olan hastalarda HPV yükü ve CIN II veya daha kötü patoloji riski

Ata Erdem TÜRK, Bahar Nur ŞAHİN, Deniz Gökçe YILDIZ, Ada ARAY, Berkay AKSOYAK, Zeynep Berra ŞİMŞEK, Tugba TEKELİOGLU, Hüseyin AKILLI, Esra KUŞÇU, Ali AYHAN