Endoservikal küretaj: Minimal servikal sitolojik anormalliklerde kolposkopik muayene normal ve yeterli olduğunda

Amaç: Normal ve yeterli kolposkopik muayenesi olan minimal servikal sitolojik anormalliği önemi belirsiz atipik skuamöz hücreli (ASCUS) veya düşük dereceli skuamöz intraepitelyal lezyon (LSIL) bulunan kadınlarda endoser- vikal displazi insidansını saptamak. Materyal ve Metot: Bu retrospektif analiz ASCUS ve LSIL servikal sitolojik anormalliği nedeniyle kolposkopi ünitesine başvuran 951 kadını kapsamaktadır. Hastaların demografik özellikleri ve kolposkopik bulguları değerlen- dirildi. Histopatolojik sonuçlar karşılaştırma amaçlı CİN 1 ve CİN 1’den ileri şeklinde iki gruba ayrıldı. Bulgular: Endoservikal küretaj pozitifliği LSIL’de 6/162 (%3,7), ASCUS’da 11/348 (%3,2) idi. Ayrıca CİN 2 ve üzeri lezyon saptanma oranı sırasıyla ASCUS, LSIL ve tüm gruplarda %0,57, %1,85, %0,98 olarak hesaplandı. Sonuçlar: Servikal sitolojisi ASCUS ve LSIL olup yeterli ve normal kolposkopik muayenesi yapılan kadınlarda endoservikal kanalda skuamöz displazi görülme oranı %0,98 ile oldukça düşük olarak bulundu. ASCUS ve LSIL smearli hastalarda ECC kullanımı tartışmalıdır. Biz ECC’nin bazı hasta gruplarında güvenle uygulanabileceğini düşünmekteyiz. Çalışmamız retrospektif olarak planlandı, sonuçları doğrulamak için prospektif randomize çalışmalara ihtiyaç vardır.

Endocervical curettage: Minimal cervical cytological abnormalities when colposcopic examination is satisfactory and normal

Background: To estimate the incidence of endocervical dysplasia in women with minimal cervical cytological abnormalities-such as atypical squamous cells of undetermined significance (ASCUS) or low grade squamous intraepithelial lesion (LSIL) who have a satisfactory and normal colposcopic examination. Materials and Methods: This is a retrospective analysis of 951 women who admitted colposcopy unit with ASCUS or LSIL on cervical cytology. Records of demographic data and colposcopic impressions were evaluated. Histopathological results of biopsies and ECC were classified into two categories as cervical intraepithelial lesion 1 (CIN 1) and worse than CIN 1 lesions for comparison. Results: Endocervical curretage (ECC) positivity was 6/162 (3.7%) in LSIL and 11/348 (3.2%) for ASCUS group. Also CIN 2 and higher-grade lesions were found 0.57% in ASCUS group and 1.85% in LSIL group and 0.98% in all groups. Conclusions: The incidence of squamous dysplasia of the endocervical canal was extremely low with the ratio of 0.98% in women who had a satisfactory and normal colposcopic examination and original cervical cytology results of consecutive ASCUS and LSIL. We consider that endocervical curettage might be safely avoided in such patients. Given the retrospective design of this study, further prospective randomised research will be needed to confirm our results.

Kaynakça

1. American College of Obstetricians and Gynecologists. Cervical cytology: Evaluation and management of abnormalities. ACOG technical bulletin no. 183. Washington, DC: American College of Obstetricians and Gynecologists 1993.

2. Drescher CW, Peter WA, Roberts JA. Contribution of endocervical curettage in evaluating abnormal cervical cytology. Obstet Gynecol 1983; 62:343–7.

3. Saltzman DH, Evans MI, Warsof SL, Friedman AJ. Endocervical curettage as a routine part of colposcopic examinations for abnormal cervical cytology. J Reprod Med 1985;30:871–3.

4. Hatch KD, Shingleton HM, Orr JW Jr, Gore H, Soong SJ. Role of endocervical curettage in colposcopy. Obstet Gynecol 1985;65:403–8.

5. Townsend DE, Ostergard DR, Mishell DR, Hirose FM. Abnormal Papanicolaou smears evaluation by colposcopy, biopsies, and endocervical curettage. Am J Obstet Gynecol 1970;108:429–34.

6. Urcuyo R, Rome RM, Nelson JH. Some observations on the value of endocervical curettage performed as an integral part of colposcopic examination of patients with abnormal cervical cytology. Am J Obstet Gynecol 1977;128:787–91.

7. Swan RW. Evaluation of colposcopic accuracy without endocervical curettage. Obstet Gynecol 1979;53:680–4.

8. Ronk DA, Jimerson GK, Merrill JA. Evaluation of abnormal cervical cytology. Obstet Gynecol 1977;49:581–6.

9. Oyer R, Hanjani R. Endocervical curettage: Does it contribute to the management of patients with abnormal cervical cytology? Gynecol Oncol 1986;25:204–11.

10. Wright TC, Massad LS, Dunton CJ Spitzer M, Wilkinson EJ, Solomon D. 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gynecol 2007;197:346–55.

11. Driggers RW, Zahn CM. To ECC or not to ECC: the question remains. Obstet Gynecol Clin North Am 2008;35:583–97.

12. Pretorius RG, Zhang WH, Belinson JL, et al. Colposcopically directed biopsy, random cervical biopsy, and endocervical curettage in the diagnosis of cervical intraepithelial neoplasia II or worse. Am J Obstet Gynecol 2004; 191:430–4.

13. Ferenczy A. Endocervical curettage has no place in the routine management of women with cervical intraepithelial neoplasia: debate. Clin Obstet Gynecol 1995;38:644–8.

14. Irvin W, Flora S, Andersen W, Stoler M, Taylor P, Rice L. Endocervical curettage. Does it contribute to the management of patients with abnormal cervical cytology? J Reprod Med 2004;49:1–7.

15. Noller KL. Endocervical curettage: a technique in search of an indication?: debate. Clin Obstet Gynecol 1995;38:649–52.

16. Massad LS, Collins YC. Using history and colposcopy to select women for endocervical curettage: results from 2,287 cases. J Reprod Med 2003; 48:1–6.

17. Solomon D, Stoler M, Jeronimo J, Khan M, Castle P, Schiffman M. Diagnostic utility of endocervical curettage in women undergoing colposcopy for equivocal or low-grade cytologic abnormalities. Obstet Gynecol 2007;110:288–95.

18. Gage JC, Duggan MA, Nation JG, Gao S, Castle PE. Detection of cervical cancer and its precursors by endocervical curettage in 13,115 colposcopically guided biopsy examinations. Am J Obstet Gynecol 2010; 203:481.e1–9.

19. Spirtos NM, Schlaerth JB, d’Ablaing G III, Morrow CP. A critical evaluation of the endocervical curettage. Obstet Gynecol 1987;70:729–33.

20. Ostergard R, Gondos B. Outpatient therapy of preinvasive cervical neoplasia: Selection of patients with the use of colposcopy. Am J Obstet Gynecol 1973;115:783–5.

21. Morrow CP, Townsend DE. Synopsis of gynecologic oncology. 3rd ed. New York: John Wiley & Sons, 1987.

22. Williams DL, Dietrich C, McBroom J. Endocervical curettage when colposcopic examination is satisfactory and normal. Obstet Gynecol 2000; 95:801–3.

Kaynak Göster

Yeni Tıp Dergisi
  • ISSN: 1300-2317
  • Yayın Aralığı: Yılda 0 Sayı
  • Başlangıç: 2018

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