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HPV Testi Pozitif, Servikal Sitolojisi Negatif Hastaların Kolposkopi Sonuçlarının Değerlendirilmesi

Yıl 2023, Cilt: 45 Sayı: 2, 252 - 258, 15.03.2023
https://doi.org/10.20515/otd.1124474

Öz

Servikal sitolojisi malignite açısından negatif, HPV (Human papillomaVirus) DNA taraması pozitif olan hastalarda tek başına HPV pozitifliğinin preinvaziv/invaziv hastalığı tanımlayabilmedeki yerini araştırmaktır. Ulusal Kanser Erken Teşhis, Tarama ve Eğitim Merkezi (KETEM) tarafından 30-65 yaş arasında primer HPV testi ile taranıp refleks sitoloji uygulanan ve Ocak 2021- Aralık 2021 tarihleri arasında kolposkopik değerlendirme yapılan hastalar retrospektif tarandı. Servikal sitolojisi negatif, HPV pozitif olan 234 hasta çalışmaya dahil edildi. Hastalar HPV sonuçlarına göre 4 gruba ayrıldı; HPV 16 ve/veya 18 pozitifler, HPV 16/18 ile birlikte diğer yüksek riskli HPV pozitifler, sadece diğer yüksek riskli HPV pozitifler, düşük riskli HPV pozitifler. Gruplar demografik veriler, kolposkopik sonuçlar açısından karşılaştırıldı. 234 hastanın mediyan yaşı 44(38-52), paritesi 2(2-3)idi. Hastaların 82’si (%35) postmenopozal iken,152 (%65) tanesi premenopozaldi. Gruplar arasında yaş, vücut kitle indeksi, gravida, parite, menopozal durum, sigara kullanımı, kolposkopik muayenede anormal bulguların bulunma oranı, uygulanan biyopsi adedi açısından fark izlenmedi. HPV sıklık sırası HPV16 (%29,6), HPV31 (%17,5), HPV52 (%9,8), HPV51(%9,4) ve HPV18 (%8,1)idi. Kolposkopik biyosi histopatolojik sonuçlarına göre, HPV 16 ve/veya 18 pozitifliğinde prekanseröz lezyon (CIN 2-3) görülme oranı diğer gruplara göre yüksekti (p=0,007). Endoservikal küretaj (ESK) histopatoloji sonuçlarına göre 2 hastada invaziv kanser varlığı saptandı. Sitoloji normal olan hastalarda HPV DNA pozitifliği endikasyonu ile yapılan kolposkopik biyopsilerde yüksek dereceli servikal displazi ve kanser görülebilmektedir. Yüksek onkojenik HPV alt tiplerinin (HPV 16- 18) direkt kolposkopiye yönlendirilmesi gerekmektedir. Aşılama programlarının yaygınlaşması ile HPV 31 gibi diğer yüksek riskli alt tipler ilerleyen yıllarda klinik önem kazanabilir.

Kaynakça

  • 1. zur Hausen H. Papillomaviruses and cancer: from basic studies to clinical application. Nat Rev Cancer. 2002 May;2(5):342–50.
  • 2. Catarino R, Petignat P, Dongui G, et al. Cervical cancer screening in developing countries at a crossroad: Emerging technologies and policy choices. World J Clin Oncol. 2015 Dec;6(6):281–90.
  • 3. Kitchener HC, Castle PE, Cox JT. Chapter 7: Achievements and limitations of cervical cytology screening. Vaccine. 2006 Aug;24 Suppl 3:S3/63-70.
  • 4. Davey E, Barratt A, Irwig L, et al. Effect of study design and quality on unsatisfactory rates, cytology classifications, and accuracy in liquid-based versus conventional cervical cytology: a systematic review. Lancet (London, England). 2006 Jan;367(9505):122–32.
  • 5. Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. J Low Genit Tract Dis. 2012 Jul;16(3):175–204.
  • 6. Perkins RB, Guido RS, Castle PE, , et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis. 2020 Apr;24(2):102–31.
  • 7. Gultekin M, Zayifoglu Karaca M, Kucukyildiz I, et al. Initial results of population based cervical cancer screening program using HPV testing in one million Turkish women. Int J cancer. 2018 May;142(9):1952–8.
  • 8. Huh WK, Ault KA, Chelmow D, , et al. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. Vol. 136, Gynecologic oncology. United States; 2015. p. 178–82.
  • 9. Egemen D, Cheung LC, Chen X, , et al. Risk Estimates Supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. J Low Genit Tract Dis. 2020 Apr;24(2):132–43.
  • 10. Wentzensen N, Massad LS, Mayeaux EJJ, et al. Evidence-Based Consensus Recommendations for Colposcopy Practice for Cervical Cancer Prevention in the United States. J Low Genit Tract Dis. 2017 Oct;21(4):216–22.
  • 11. Schiffman M, Boyle S, Raine-Bennett T, et al. The Role of Human Papillomavirus Genotyping in Cervical Cancer Screening: A Large-Scale Evaluation of the cobas HPV Test. Cancer Epidemiol biomarkers Prev a Publ Am Assoc Cancer Res cosponsored by Am Soc Prev Oncol. 2015 Sep;24(9):1304–10.
  • 12. Sankaranarayanan R, Nene BM, Shastri SS, et al. HPV screening for cervical cancer in rural India. N Engl J Med. 2009 Apr;360(14):1385–94.
  • 13. de Villiers E-M, Fauquet C, Broker TR, et al.. Classification of papillomaviruses. Virology. 2004 Jun;324(1):17–27.
  • 14. de Sanjosé S, Diaz M, Castellsagué X, , et al. Worldwide prevalence and genotype distribution of cervical human papillomavirus DNA in women with normal cytology: a meta-analysis. Lancet Infect Dis. 2007 Jul;7(7):453–9.
  • 15. Gök S., Can Gök B & CDA. HPV-16/18 pozitif kadınların takibinde kolposkopi eşliğinde alınan servikal biyopsinin önemi. Pamukkale Tıp Dergisi,. 2021;14(1),:253–61.
  • 16. Herrero R, Castle PE, Schiffman M, et al. Epidemiologic profile of type-specific human papillomavirus infection and cervical neoplasia in Guanacaste, Costa Rica. J Infect Dis. 2005 Jun;191(11):1796–807.
  • 17. Adcock R, Cuzick J, Hunt WC, et al. Role of HPV Genotype, Multiple Infections, and Viral Load on the Risk of High-Grade Cervical Neoplasia. Cancer Epidemiol biomarkers Prev a Publ Am Assoc Cancer Res cosponsored by Am Soc Prev Oncol. 2019 Nov;28(11):1816–24.
  • 18. Bruni L, Diaz M, Castellsagué X, et al. Cervical human papillomavirus prevalence in 5 continents: meta-analysis of 1 million women with normal cytological findings. J Infect Dis. 2010 Dec;202(12):1789–99.
  • 19. Monsonego J, Cox JT, Behrens C, et al. Prevalence of high-risk human papilloma virus genotypes and associated risk of cervical precancerous lesions in a large U.S. screening population: data from the ATHENA trial. Gynecol Oncol. 2015 Apr;137(1):47–54.
  • 20. Wright TCJ, Stoler MH, Sharma A, et al. . Evaluation of HPV-16 and HPV-18 genotyping for the triage of women with high-risk HPV+ cytology-negative results. Am J Clin Pathol. 2011 Oct;136(4):578–86.

Evaluation of Colposcopy Results of HPV Test Positive and Cervical Cytology Negative Patients

Yıl 2023, Cilt: 45 Sayı: 2, 252 - 258, 15.03.2023
https://doi.org/10.20515/otd.1124474

Öz

To investigate the role of HPV(Human papillomaVirus) positivity alone in defining preinvasive/invasive disease in patients with negative cervical cytology for malignancy and positive HPVDNA screening. Patients aged 30-65 years, who were screened with primary HPV test and reflex cytology by the National Cancer Early Diagnosis, Screening and Education Center (KETEM), and who underwent colposcopic evaluation between July 2021 and March 2022, were retrospectively screened. 234 patients with negative cervical cytology and positive HPV were included in the study. The patients were divided into 4 groups according to HPV results; HPV 16 and/or 18, HPV 16/18 together with other high-risk HPV, only other high-risk HPV, low-risk HPV. Groups were compared in terms of demographic data and colposcopic results. The median age was 44(38-52). While 82(35%) of the patients were postmenopausal, 152(65%) were premenopausal. There was no difference between the groups in terms of age, body mass index, gravida, parity, menopausal status, smoking, the rate of abnormal findings in colposcopic examination, and the number of biopsies performed. The frequencies of HPV types were HPV16 (29.6%), HPV31 (17.5%), HPV52 (9.8%), HPV51 (9.4%) and HPV18 (8.1%). According to colposcopic biopsies, the rate of precancerous lesion in HPV 16 and/or 18 positivity was higher than other groups(p=0.007). According to endocervical curettage, invasive cancer was detected in two patients. High-risk oncogenic HPV subtypes (HPV 16-18) should be referred to colposcopy. With the spread of vaccination programs, other high-risk subtypes such as HPV type 31 may gain clinical importance in the upcoming years.

Kaynakça

  • 1. zur Hausen H. Papillomaviruses and cancer: from basic studies to clinical application. Nat Rev Cancer. 2002 May;2(5):342–50.
  • 2. Catarino R, Petignat P, Dongui G, et al. Cervical cancer screening in developing countries at a crossroad: Emerging technologies and policy choices. World J Clin Oncol. 2015 Dec;6(6):281–90.
  • 3. Kitchener HC, Castle PE, Cox JT. Chapter 7: Achievements and limitations of cervical cytology screening. Vaccine. 2006 Aug;24 Suppl 3:S3/63-70.
  • 4. Davey E, Barratt A, Irwig L, et al. Effect of study design and quality on unsatisfactory rates, cytology classifications, and accuracy in liquid-based versus conventional cervical cytology: a systematic review. Lancet (London, England). 2006 Jan;367(9505):122–32.
  • 5. Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. J Low Genit Tract Dis. 2012 Jul;16(3):175–204.
  • 6. Perkins RB, Guido RS, Castle PE, , et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis. 2020 Apr;24(2):102–31.
  • 7. Gultekin M, Zayifoglu Karaca M, Kucukyildiz I, et al. Initial results of population based cervical cancer screening program using HPV testing in one million Turkish women. Int J cancer. 2018 May;142(9):1952–8.
  • 8. Huh WK, Ault KA, Chelmow D, , et al. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. Vol. 136, Gynecologic oncology. United States; 2015. p. 178–82.
  • 9. Egemen D, Cheung LC, Chen X, , et al. Risk Estimates Supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. J Low Genit Tract Dis. 2020 Apr;24(2):132–43.
  • 10. Wentzensen N, Massad LS, Mayeaux EJJ, et al. Evidence-Based Consensus Recommendations for Colposcopy Practice for Cervical Cancer Prevention in the United States. J Low Genit Tract Dis. 2017 Oct;21(4):216–22.
  • 11. Schiffman M, Boyle S, Raine-Bennett T, et al. The Role of Human Papillomavirus Genotyping in Cervical Cancer Screening: A Large-Scale Evaluation of the cobas HPV Test. Cancer Epidemiol biomarkers Prev a Publ Am Assoc Cancer Res cosponsored by Am Soc Prev Oncol. 2015 Sep;24(9):1304–10.
  • 12. Sankaranarayanan R, Nene BM, Shastri SS, et al. HPV screening for cervical cancer in rural India. N Engl J Med. 2009 Apr;360(14):1385–94.
  • 13. de Villiers E-M, Fauquet C, Broker TR, et al.. Classification of papillomaviruses. Virology. 2004 Jun;324(1):17–27.
  • 14. de Sanjosé S, Diaz M, Castellsagué X, , et al. Worldwide prevalence and genotype distribution of cervical human papillomavirus DNA in women with normal cytology: a meta-analysis. Lancet Infect Dis. 2007 Jul;7(7):453–9.
  • 15. Gök S., Can Gök B & CDA. HPV-16/18 pozitif kadınların takibinde kolposkopi eşliğinde alınan servikal biyopsinin önemi. Pamukkale Tıp Dergisi,. 2021;14(1),:253–61.
  • 16. Herrero R, Castle PE, Schiffman M, et al. Epidemiologic profile of type-specific human papillomavirus infection and cervical neoplasia in Guanacaste, Costa Rica. J Infect Dis. 2005 Jun;191(11):1796–807.
  • 17. Adcock R, Cuzick J, Hunt WC, et al. Role of HPV Genotype, Multiple Infections, and Viral Load on the Risk of High-Grade Cervical Neoplasia. Cancer Epidemiol biomarkers Prev a Publ Am Assoc Cancer Res cosponsored by Am Soc Prev Oncol. 2019 Nov;28(11):1816–24.
  • 18. Bruni L, Diaz M, Castellsagué X, et al. Cervical human papillomavirus prevalence in 5 continents: meta-analysis of 1 million women with normal cytological findings. J Infect Dis. 2010 Dec;202(12):1789–99.
  • 19. Monsonego J, Cox JT, Behrens C, et al. Prevalence of high-risk human papilloma virus genotypes and associated risk of cervical precancerous lesions in a large U.S. screening population: data from the ATHENA trial. Gynecol Oncol. 2015 Apr;137(1):47–54.
  • 20. Wright TCJ, Stoler MH, Sharma A, et al. . Evaluation of HPV-16 and HPV-18 genotyping for the triage of women with high-risk HPV+ cytology-negative results. Am J Clin Pathol. 2011 Oct;136(4):578–86.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Fatma Nurgül Taşgöz 0000-0001-9181-7574

Nergis Kender Erturk 0000-0002-2902-9670

Mehmet Özkanlı 0000-0002-6413-2278

Anıl Erturk 0000-0003-4559-7536

Yayımlanma Tarihi 15 Mart 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 45 Sayı: 2

Kaynak Göster

Vancouver Taşgöz FN, Kender Erturk N, Özkanlı M, Erturk A. HPV Testi Pozitif, Servikal Sitolojisi Negatif Hastaların Kolposkopi Sonuçlarının Değerlendirilmesi. Osmangazi Tıp Dergisi. 2023;45(2):252-8.


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