Muzaffer Seyhan ÇIKMAN, İSMET GÜN, Burak GİRAY, Önder SAKİN, Ali DOĞUKAN ANĞIN, Canan Kabaca KOCAKUŞAK

Postkoital Kanamalı Hastalarda Servikal Sitolojinin Önemi

Amaç: Primer amacımız postkoital kanama şikayeti ile gelen hastalarda sitolojinin preinvaziv ve/veya invaziv servikal patolojilerin tespit edilmesinde etkinliğini araştırmak iken sekonder amacımız şiddetli kanama, anormal sitoloji ve normal sitoloji durumlarında yönetim şeklini belirlemektir. Gereçler ve Yöntem: Ocak 2013 ile Eylül 2016 tarihleri arasında Zeynep Kamil Kadın ve Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi’ne postkoital kanama şikayeti ile başvuran ve kolposkopi yapılan 317 hasta retrospektif olarak, aşırı kanama nedeniyle smear alınamayanlar (Grup 1), smear sonucu normal olanlar (Grup 2) ve smear sonucu anormal olanlar (Grup 3) şeklinde 3 gruba ayrıldı. Biyopsi sonuçları hem gruplar arasında hem de menopoz statülerine göre karşılaştırıldı. İstatistik için SPSS 15 kullanıldı. Pap smear için preinvaziv ve invaziv patoloji açısından sensitivite ve spesifisite hesaplandı. Bulgular: Gruplar arasında menopoz oranı ve yaş açısından fark gözlenmedi. Toplam hasta grubunda en yüksek invaziv kanser oranları şiddetli kanama nedeniyle smear alınamayan ( grup 1) hastalarda, en düşük oranlar ise normal sitolojili (grup 2) hastalarda gözlendi (%12.5, %1.9 ve %4; sırasıyla, p< 0.0001). İnvaziv kanser açışından sadece grup 1-2 arasında (p=0.0034), preinvaziv/invaziv kanser açısından ise hem grup 1-3 (p=0.004) hem de grup 2-3 arasında istatistiksel olarak anlamlı fark olduğu gözlendi (p

Importance of Cervical Cytology in Patients with Postcoital Bleeding

Objective: Our primary aim is to investigate the efficacy of cytology to detect preinvasive and/or invasive cervical pathologies in patients with postcoital bleeding and our secondary aim is to determine the management of postcoital bleeding with severe bleeding, abnormal cytology and normal cytology. Material and Methods: Between January 2013 and September 2016, at Zeynep Kamil Women’s and Children’s Diseases Training and Research Hospital, 317 patients who underwent colposcopy for postcoital bleeding were retrospectively evaluated and divided into 3 groups: without smear due to excessive hemorrhage (Group 1), with normal smear (Group 2) and with abnormal smear (Group 3). Biopsy results were compared between both groups and menopausal status. SPSS 15 was used for statistics. Sensitivity and specificity of pap smear were calculated for preinvasive and invasive pathology. Results: Menopause rate and age were not different between the groups. In the total patient group, it was observed that the highest rate of invasive cancer were in group without smear due to severe bleeding (group 1), and lowest rate were in group with normal cytology (group 2). The difference was statistically significant between the 3 groups (12.5%, 1.9% and 4%, respectively, p< 0.0001). Similar rates were also found in the premenopausal group (12.8%, 1.8% and 4.5%, respectively, p

PDF

___

Shapley M, Jordan J, Croft PR. A systematic review of postcoital bleeding and risk of cervical cancer. Br J Gen Pract 2006; 56(527): 453- 60.
Tarney CM & Han J. Postcoital bleeding: a review on etiology, diagnosis, and management. Obstetrics and gynecology international, 2014.
Luesley D, Leeson S. Colposcopy and programme management. Guidelines for the NHS cervical screening programme. NHSCSP Publication No. 20. Sheffield, UK: NHSCSP, 2004.
Tehranian A, Rezaii N, Mohit M, Eslami B, Arab M, & Asgari Z. Evaluation of women presenting with postcoital bleeding by cytology and colposcopy. Int J Gynaecol Obstet 2009; 105:18.
Selo-Ojeme DO, Dayoub N, Patel A, Metha M. A clinico-pathological study of postcoital bleeding. Arch Gynecol Obstet 2004; 270:34.
Viikki M, Pukkala E, Hakama M. Bleeding symptoms and subsequent risk of gynecological and other cancers. Acta Obstet Gynecol Scand 1998; 77:564.
Pretorius R, Semrad N, Watring W, Fotheringham N. Presentation of cervical cancer. Gynecol Oncol 1991; 42:48.
Goldstein RB, Bree LR, Benson CB, Benacerraf BR, Bloss JD, Carlos R, et al. Evaluation of the woman with postmenopausal bleeding: society of radiologists in ultrasound-sponsored consensus conference statement. Journal of Ultrasound in Medicine, 2001, vol. 20, no. 10, pp. 1025–1036.
Rosenthal AN, Panoskaltsis T, Smith T, & Soutter WP. The frequency of significant pathology in women attending a general gynaecological service for postcoital bleeding. BJOG: An International Journal of Obstetrics & Gynaecology. 2001, 108(1), 103-106.
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet Tieulent J, & Jemal A. Global cancer statistics, 2012. CA: a cancer journal for clinicians, 2015, 65(2), 87-108.
Khattab AF, Ewies AA, Appleby D, Cruickshank DJ. The outcome of referral with postcoital bleeding (PCB). J Obstet Gynaecol 2005; 25(3): 279- 82.