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CERVICAL INTRAEPITHELIAL LESIONS AND THE PLACE OF CERVICAL COLPOSCOPY IN HIGH RISK HPV TYPES

Year 2023, Volume: 24 Issue: 1, 43 - 48, 03.01.2023
https://doi.org/10.18229/kocatepetip.939533

Abstract

OBJECTIVE: In our study, patients with low-grade cervical intraepithelial lesion (LSIL), high-grade cervical intraepithelial lesion (HSIL), non-typical squamous cells (ASCUS) of indeterminate significance, and patients with eruption on cervical examination and human papilloma virus (HPV) test. We aimed to compare the results of HPV, smear and biopsy in patients who were positive followed by colposcopic biopsy.
MATERIAL AND METHODS: In total, 186 patients were included as the study group. Cervical smears taken from the patients were evaluated. Patients whose cervical smear results were determined as ASCUS, LSIL and HSIL and HPV positive patients were referred for colposcopy. We grouped the HPV types 16, 18, 31 and 33 as high-risk and the others as low-risk. Accordingly, HPV, smear and biopsy results were compared.
RESULTS: Of the 186 patients included in the study, 74 (39.7%) were in menopause. Colposcopy was performed due to the detection of HPV positivity in 103 (55.3%) of the patients who underwent colposcopy. 82 of these patients were in the high risk HPV group. Colposcopy was performed in 35 patients (18.8%) with ASCUS, 33 patients with cervical erosion (17.7%), 12 patients with LSIL (6.5%) and 3 patients (1.6%) with HSIL. If we look at the pathology results of the biopsies taken from the patients who underwent colposcopy, 134 of them (72%) came as benign. When the colposcopic biopsy results of 121 patients whose smear results were found to be without malignancy, 19 patients had CIN1 (15.7%), 6 patients (5%), and 2 patients CIN3 (1.7%). According to smear results, advanced epithelial anomalies (CIN 2 and 3) were observed in 25% of patients who received LSIL, while this rate was found to be 50% in patients with HSIL. When HPV types and colposcopic biopsy results were compared, CIN 1, 2 and 3 were detected as a rate of 37.8 in the high-risk HPV types , while this rate was 9.5% in the low-risk group (p <0.016).
CONCLUSIONS: It was concluded that smearin is a screening test and the diagnosis should be confirmed by biopsy under colposcopy in the presence of LSIL or HSIL. In addition, the importance of colposcopic biopsy is understood, regardless of the smear result, especially in cases with positive HPV types.

References

  • 1. Company A, Montserrat M, Bosch FX, et al. Training in the prevention of cervical cancer: advantages of e-learning. Ecancermedicalscience. 2015;8;9:580.
  • 2. Tanabodee J, Thepsuwan K, Karalak A, et al. Comparison of Efficacy in Abnormal Cervical Cell Detection between Liquid-based Cytology and Conventional Cytology. Asian Pac J Cancer Prev. 2015;16(16):7381-4.
  • 3. Duesing N, Schwarz J, Choschzick M, et al. Assessment of cervical intraepithelial neoplasia (CIN) with colposcopic biopsy and efficacy of loop electrosurgical excision procedure (LEEP). Arch Gynecol Obstet. 2012;286(6):1549-54.
  • 4. Labani S, Asthana S. Age-specific performance of careHPV versus Papanicolaou and visual inspection of cervix with acetic acid testing in a primary cervical cancer screening. J Epidemiol Community Health. 2016;70(1):72-7.
  • 5. Poomtavorn Y, Suwannarurk K. Accuracy of visual inspection with acetic acid in detecting high-grade cervical intraepithelial neoplasia in pre- and post-menopausal Thai women with minor cervical cytological abnormalities. Asian Pac J Cancer Prev. 2015;16(6):2327-31.
  • 6. Kingnate C, Supoken A, Kleebkaow P, et al. Is Age an Independent Predictor of High-Grade Histopathology in Women Referred for Colposcopy after Abnormal Cervical Cytology? Asian Pac J Cancer Prev. 2015;16(16):7231-5.
  • 7. Hilal Z, Tempfer C, Schiermeier S, et al. Progression or Regression? - Strengths and Weaknesses of the New Munich Nomenclature III for Cervix Cytology. Geburtshilfe Frauenheilkd. 2015;75(10):1051-57.
  • 8. Underwood M, Arbyn M, Parry-Smith W, et al. Accuracy of colposcopy-directed punch biopsies: a systematic review and meta-analysis. BJOG. 2012;119(11):1293-301.
  • 9. Saslow D, Solomon D, Lawson HW, et al. ACS-ASCCP-ASCP Cervical Cancer Guideline Committee. 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. CA Cancer J Clin. 2012;62(3):147-72.
  • 10. Moss EL, Hadden P, Douce G, et al. Is the colposcopically directed punch biopsy a reliable diagnostic test in women with minor cytological lesions? J Low Genit Tract Dis. 2012;16(4):421-6.
  • 11. Tantitamit T, Termrungruanglert W, Oranratanaphan S, et al. Cost-Effectiveness Analysis of Different Management Strategies for Detection CIN2+ of Women with Atypical Squamous Cells of Undetermined Significance (ASC-US) Pap Smear in Thailand. Asian Pac J Cancer Prev. 2015;16(16):6857-62.
  • 12. Pouliakis A, Karakitsou E, Chrelias C, et al. The Application of Classification and Regression Trees for the Triage of Women for Referral to Colposcopy and the Estimation of Risk for Cervical Intraepithelial Neoplasia: A Study Based on 1625 Cases with Incomplete Data from Molecular Tests. Biomed Res Int. 2015;2015:914740.
  • 13. Redman CWE, Kesic V, Cruickshank ME, et al. European Federation for Colposcopy and Pathology of the Lower Genital Tract (EFC) and the European Society of Gynecologic Oncology (ESGO). European consensus statement on essential colposcopy. Eur J Obstet Gynecol Reprod Biol. 2021;256:57-62.
  • 14. Davey DD, Neal MH, Wilbur DC, et al. Bethesda 2001 implementation and reporting rates: 2003 practices of participants in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology. Arch Pathol Lab Med. 2004;128(11):1224-9.
  • 15. Bradbury M, Rabasa J, Murcia MT, et al. Can We Reduce Overtreatment of Cervical High-Grade Squamous Intraepithelial Lesions? J Low Genit Tract Dis. 2022 1;26(1):20-26.
  • 16. Saha R, Thapa M. Correlation of cervical cytology with cervical histology. Kathmandu Univ Med J (KUMJ). 2005;3(3):222-4.
  • 17. Karapınar OS, Dolapçıoğlu K, Özer C. Servikal premalign lezyonlarda kolposkopinin yeri. Türk Jinekolojik Onkoloji Dergisi. 2015;4:131-6.
  • 18. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 202;71(3):209-49.
  • 19. Hopman EH, Rozendaal L, Voorhorst FJ, et al. High risk human papillomavirus in women with normal cervical cytology prior to the development of abnormal cytology and colposcopy. BJOG. 2000;107(5):600-4.
  • 20. Adam E, Berkova Z, Daxnerova Z, et al. Papillomavirus detection: demographic and behavioral characteristics influencing the identification of cervical disease. Am J Obstet Gynecol. 2000;182(2):257-64.
  • 21. Juárez-González K, Paredes-Cervantes V, Martínez-Salazar M, et al. Prevalencia del virus del papiloma humano oncogénico en pacientes con lesión cervical [Prevalence of oncogenic human papillomavirus in patients with cervical lesion]. Rev Med Inst Mex Seguro Soc. 2020 18;58(3):243-49.
  • 22. Demir ET, Ceyhan M, Simsek M, et al. The prevalence of different HPV types in Turkish women with a normal Pap smear. J Med Virol. 2012;84(8):1242-7.
  • 23. Sung YE, Ki EY, Lee YS, et al. Can human papillomavirus (HPV) genotyping classify non-16/18 high-risk HPV infection by risk stratification? J Gynecol Oncol. 2016;27(6):e56.
  • 24. Branca M, Ciotti M, Santini D, et al. p16(INK4A) expression is related to grade of cin and high-risk human papillomavirus but does not predict virus clearance after conization or disease outcome. Int J Gynecol Pathol. 2004;23(4):354-65.

SERVİKAL İNTRAEPİTELYAL LEZYONLARDA VE YÜKSEK RİSKLİ HPV TİPLERİNDE SERVİKAL KOLPOSKOPİNİN YERİ

Year 2023, Volume: 24 Issue: 1, 43 - 48, 03.01.2023
https://doi.org/10.18229/kocatepetip.939533

Abstract

AMAÇ: Bu çalışmada, smear sonucu düşük dereceli servikal intraepitelyal lezyon (LSIL), yüksek dereceli servikal intraepiteliyal lezyon (HSIL), önemi belirsiz tipik olmayan yassı hücreler (ASCUS) tespit edilen, servikal muayenede erzoyon saptanan hastalar ve yapılan human papilloma virüs (HPV) testi pozitif olan takiben kolposkopik biyopsi uygulanan hastalarımızda HPV, smear ve biyopsi sonuçları karşılaştırılması amaçlanmıştır.
GEREÇ VE YÖNTEM: Toplamda çalışma grubu olarak 186 hasta dahil edildi. Hastalardan alınan servikal smearlar değerlendirildi. Servikal smear sonucu; ASCUS, LSIL ve HSIL, olan hastalar ile HPV pozitif hastalar kolposkopiye yönlendirildi. HPV tiplerinden 16, 18, 31 ve 33 olanları yüksek riskli, diğerlerini düşük riskli olarak gruplandırdık. Buna göre HPV, smear ve biyopsi sonuçları karşılaştırıldı.
BULGULAR: Çalışmaya dahil edilen 186 hastanın 74’ü (%39,7) menopozdaydı. Kolposkopi yapılan hastaların 103’ünde (%55,3) HPV testi sonucu pozitif saptanması nedenli kolposkopi yapıldı. Bu hastaların 82’si yüksek riskli HPV grubundaydı. ASCUS nedenli 35 (%18,8) olguya, servikal erozyon nedenli 33 hastaya (%17,7), LSIL nedenli 12 hastaya (%6,5) HSIL nedenli 3 hastaya (%1,6) kolposkopi yapıldı. Kolposkopi yapılan hastaların alınan biyopsilerinin patoloji sonuçlarına bakacak olursak 134’ü (%72) benign olarak geldi. Smear sonucu malignite izlenmedi olarak gelen 121 hastanın kolposkopik biyopsi sonuçları değerlendirildiğinde 19 hastada CIN1 (%15,7), 6 hastada CIN2(%5), 2 hastada CIN3(%1,7) saptandı. Smear sonucuna göre LSIL gelen hastaların %25’inde ileri düzeyde epitelyal anomali (CIN 2 ve 3) gözlenirken, HSIL olan hastalarda bu oran %50 olarak tespit edilmiştir. HPV tipleri ile kolposkopik biyopsi sonuçları karşılaştırıldığında yüksek riskli HPV tipleri ile %37,8 oranında CIN 1, 2 ve 3 tespit edilirken, düşük riskli grupta bu oran %9,5 olarak bulunmuştur (p<0.016).
SONUÇ: Smear tarama testi olarak kullanılmalıdır ve LSIL veya HSIL varlığında mutlaka kolposkopik biyopsi ile tanının doğrulanması gereklidir. Ayrıca özellikle yüksek riskli HPV tiplerinin pozitifliği tespit edilen olgularda smear sonucundan bağımsız olarak da kolposkopik biyopsinin önemi anlaşılmaktadır.

References

  • 1. Company A, Montserrat M, Bosch FX, et al. Training in the prevention of cervical cancer: advantages of e-learning. Ecancermedicalscience. 2015;8;9:580.
  • 2. Tanabodee J, Thepsuwan K, Karalak A, et al. Comparison of Efficacy in Abnormal Cervical Cell Detection between Liquid-based Cytology and Conventional Cytology. Asian Pac J Cancer Prev. 2015;16(16):7381-4.
  • 3. Duesing N, Schwarz J, Choschzick M, et al. Assessment of cervical intraepithelial neoplasia (CIN) with colposcopic biopsy and efficacy of loop electrosurgical excision procedure (LEEP). Arch Gynecol Obstet. 2012;286(6):1549-54.
  • 4. Labani S, Asthana S. Age-specific performance of careHPV versus Papanicolaou and visual inspection of cervix with acetic acid testing in a primary cervical cancer screening. J Epidemiol Community Health. 2016;70(1):72-7.
  • 5. Poomtavorn Y, Suwannarurk K. Accuracy of visual inspection with acetic acid in detecting high-grade cervical intraepithelial neoplasia in pre- and post-menopausal Thai women with minor cervical cytological abnormalities. Asian Pac J Cancer Prev. 2015;16(6):2327-31.
  • 6. Kingnate C, Supoken A, Kleebkaow P, et al. Is Age an Independent Predictor of High-Grade Histopathology in Women Referred for Colposcopy after Abnormal Cervical Cytology? Asian Pac J Cancer Prev. 2015;16(16):7231-5.
  • 7. Hilal Z, Tempfer C, Schiermeier S, et al. Progression or Regression? - Strengths and Weaknesses of the New Munich Nomenclature III for Cervix Cytology. Geburtshilfe Frauenheilkd. 2015;75(10):1051-57.
  • 8. Underwood M, Arbyn M, Parry-Smith W, et al. Accuracy of colposcopy-directed punch biopsies: a systematic review and meta-analysis. BJOG. 2012;119(11):1293-301.
  • 9. Saslow D, Solomon D, Lawson HW, et al. ACS-ASCCP-ASCP Cervical Cancer Guideline Committee. 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. CA Cancer J Clin. 2012;62(3):147-72.
  • 10. Moss EL, Hadden P, Douce G, et al. Is the colposcopically directed punch biopsy a reliable diagnostic test in women with minor cytological lesions? J Low Genit Tract Dis. 2012;16(4):421-6.
  • 11. Tantitamit T, Termrungruanglert W, Oranratanaphan S, et al. Cost-Effectiveness Analysis of Different Management Strategies for Detection CIN2+ of Women with Atypical Squamous Cells of Undetermined Significance (ASC-US) Pap Smear in Thailand. Asian Pac J Cancer Prev. 2015;16(16):6857-62.
  • 12. Pouliakis A, Karakitsou E, Chrelias C, et al. The Application of Classification and Regression Trees for the Triage of Women for Referral to Colposcopy and the Estimation of Risk for Cervical Intraepithelial Neoplasia: A Study Based on 1625 Cases with Incomplete Data from Molecular Tests. Biomed Res Int. 2015;2015:914740.
  • 13. Redman CWE, Kesic V, Cruickshank ME, et al. European Federation for Colposcopy and Pathology of the Lower Genital Tract (EFC) and the European Society of Gynecologic Oncology (ESGO). European consensus statement on essential colposcopy. Eur J Obstet Gynecol Reprod Biol. 2021;256:57-62.
  • 14. Davey DD, Neal MH, Wilbur DC, et al. Bethesda 2001 implementation and reporting rates: 2003 practices of participants in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology. Arch Pathol Lab Med. 2004;128(11):1224-9.
  • 15. Bradbury M, Rabasa J, Murcia MT, et al. Can We Reduce Overtreatment of Cervical High-Grade Squamous Intraepithelial Lesions? J Low Genit Tract Dis. 2022 1;26(1):20-26.
  • 16. Saha R, Thapa M. Correlation of cervical cytology with cervical histology. Kathmandu Univ Med J (KUMJ). 2005;3(3):222-4.
  • 17. Karapınar OS, Dolapçıoğlu K, Özer C. Servikal premalign lezyonlarda kolposkopinin yeri. Türk Jinekolojik Onkoloji Dergisi. 2015;4:131-6.
  • 18. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 202;71(3):209-49.
  • 19. Hopman EH, Rozendaal L, Voorhorst FJ, et al. High risk human papillomavirus in women with normal cervical cytology prior to the development of abnormal cytology and colposcopy. BJOG. 2000;107(5):600-4.
  • 20. Adam E, Berkova Z, Daxnerova Z, et al. Papillomavirus detection: demographic and behavioral characteristics influencing the identification of cervical disease. Am J Obstet Gynecol. 2000;182(2):257-64.
  • 21. Juárez-González K, Paredes-Cervantes V, Martínez-Salazar M, et al. Prevalencia del virus del papiloma humano oncogénico en pacientes con lesión cervical [Prevalence of oncogenic human papillomavirus in patients with cervical lesion]. Rev Med Inst Mex Seguro Soc. 2020 18;58(3):243-49.
  • 22. Demir ET, Ceyhan M, Simsek M, et al. The prevalence of different HPV types in Turkish women with a normal Pap smear. J Med Virol. 2012;84(8):1242-7.
  • 23. Sung YE, Ki EY, Lee YS, et al. Can human papillomavirus (HPV) genotyping classify non-16/18 high-risk HPV infection by risk stratification? J Gynecol Oncol. 2016;27(6):e56.
  • 24. Branca M, Ciotti M, Santini D, et al. p16(INK4A) expression is related to grade of cin and high-risk human papillomavirus but does not predict virus clearance after conization or disease outcome. Int J Gynecol Pathol. 2004;23(4):354-65.
There are 24 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Articles
Authors

Metin Şentürk 0000-0002-0385-4381

Vehbi Yavuz Tokgöz 0000-0002-4113-385X

Publication Date January 3, 2023
Acceptance Date March 1, 2022
Published in Issue Year 2023 Volume: 24 Issue: 1

Cite

APA Şentürk, M., & Tokgöz, V. Y. (2023). SERVİKAL İNTRAEPİTELYAL LEZYONLARDA VE YÜKSEK RİSKLİ HPV TİPLERİNDE SERVİKAL KOLPOSKOPİNİN YERİ. Kocatepe Tıp Dergisi, 24(1), 43-48. https://doi.org/10.18229/kocatepetip.939533
AMA Şentürk M, Tokgöz VY. SERVİKAL İNTRAEPİTELYAL LEZYONLARDA VE YÜKSEK RİSKLİ HPV TİPLERİNDE SERVİKAL KOLPOSKOPİNİN YERİ. KTD. January 2023;24(1):43-48. doi:10.18229/kocatepetip.939533
Chicago Şentürk, Metin, and Vehbi Yavuz Tokgöz. “SERVİKAL İNTRAEPİTELYAL LEZYONLARDA VE YÜKSEK RİSKLİ HPV TİPLERİNDE SERVİKAL KOLPOSKOPİNİN YERİ”. Kocatepe Tıp Dergisi 24, no. 1 (January 2023): 43-48. https://doi.org/10.18229/kocatepetip.939533.
EndNote Şentürk M, Tokgöz VY (January 1, 2023) SERVİKAL İNTRAEPİTELYAL LEZYONLARDA VE YÜKSEK RİSKLİ HPV TİPLERİNDE SERVİKAL KOLPOSKOPİNİN YERİ. Kocatepe Tıp Dergisi 24 1 43–48.
IEEE M. Şentürk and V. Y. Tokgöz, “SERVİKAL İNTRAEPİTELYAL LEZYONLARDA VE YÜKSEK RİSKLİ HPV TİPLERİNDE SERVİKAL KOLPOSKOPİNİN YERİ”, KTD, vol. 24, no. 1, pp. 43–48, 2023, doi: 10.18229/kocatepetip.939533.
ISNAD Şentürk, Metin - Tokgöz, Vehbi Yavuz. “SERVİKAL İNTRAEPİTELYAL LEZYONLARDA VE YÜKSEK RİSKLİ HPV TİPLERİNDE SERVİKAL KOLPOSKOPİNİN YERİ”. Kocatepe Tıp Dergisi 24/1 (January 2023), 43-48. https://doi.org/10.18229/kocatepetip.939533.
JAMA Şentürk M, Tokgöz VY. SERVİKAL İNTRAEPİTELYAL LEZYONLARDA VE YÜKSEK RİSKLİ HPV TİPLERİNDE SERVİKAL KOLPOSKOPİNİN YERİ. KTD. 2023;24:43–48.
MLA Şentürk, Metin and Vehbi Yavuz Tokgöz. “SERVİKAL İNTRAEPİTELYAL LEZYONLARDA VE YÜKSEK RİSKLİ HPV TİPLERİNDE SERVİKAL KOLPOSKOPİNİN YERİ”. Kocatepe Tıp Dergisi, vol. 24, no. 1, 2023, pp. 43-48, doi:10.18229/kocatepetip.939533.
Vancouver Şentürk M, Tokgöz VY. SERVİKAL İNTRAEPİTELYAL LEZYONLARDA VE YÜKSEK RİSKLİ HPV TİPLERİNDE SERVİKAL KOLPOSKOPİNİN YERİ. KTD. 2023;24(1):43-8.

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