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Servikal kanser taramasında saptanan önemi belirlenemeyen atipik skuamoz hücrelerin klinik değerlendirmesi: Eskişehir deneyimi

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Hulusi Göktuğ GÜRER
Hulusi Göktuğ GÜRER
Hulusi Göktuğ GÜRER
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Ceren YILDIZ EREN
Ceren YILDIZ EREN
Ceren YILDIZ EREN
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Özlem ÖZGÜR GÜRSOY
Özlem ÖZGÜR GÜRSOY
Özlem ÖZGÜR GÜRSOY
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Ramazan BAYIRLI
Ramazan BAYIRLI
Ramazan BAYIRLI
  • This person is not on ResearchGate, or hasn't claimed this research yet.
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      

Evaluation of the clinical signicance of atypical squamous cells, whose signicance
could not be determined in cervical cancer screening: Eskişehir experience

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Pamukkale Medical Journal
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


 

Research Article
 








Doi no: https://dx.doi.org/10.31362/patd.856068


󰀨
p
             
  
    







    

    
    
     

     
     
     
    



     

     
 
     
   
    
       
     

   


  



    

    
   


   



   

      

    






    
   
   
    


 
     

  
      
     
     
    

   

Pamukkale Tıp Dergisi 2021;14(4):862-868 Gürer ve ark.


     

    
   
      
    
   
  

    

    

      

      
    
     
,



      
     
     

   
   
     
  
    
    


    
   

    

  
   
     
    p

    

Bulgular
   
    
     
     
     
   


      
    
p
   
     
    
     
    
   

    
   


Özellik   
 


 

 


 
Damarlar








   

Atipik skuamoz hücrelerde kolposkopi/biyopsi


     
    
     
     

  

    

    
     

p

 
 
 










Kontrol





 






Yok








(n=68)

(n=85)

 
HR-HPV DNA

















RCI
0-2

5-8











Pamukkale Tıp Dergisi 2021;14(4):862-868 Gürer ve ark.
866
  
     
      


   

     



       
       



   
   
   
   

    
     

      
 
p

  
     
    
    
     
    
    
   

  
   
 
     
   
     
    
      
     

     


     
     

     
   

     

    


    
      

    
     

    
       
    

    
        
     
    

      

    
     
  
  
 
       


     
    
 
     
     

     
  

   
     

Atipik skuamoz hücrelerde kolposkopi/biyopsi

 
  
   
    
     
    
     
    
   
    
     
    

      
   

    

  
    
     
     

   

     
  
  
   



     
    
     
   
        
     
    
     
     
    
    
    

     
  


  
    
    
       
    
  
    
    


   
      
     
   


     
     
     
   
      
    
     
     

    


1.       
      

2. 
  

3. 

   

4.       
      
    

5.      
       

6.        
     
   

7.       
     
 

Pamukkale Tıp Dergisi 2021;14(4):862-868 Gürer ve ark.
868
8. 

  


9.     
     
     
  

10.   
     
 

11.         
     
     
     
        
  

12.       
       



13.         
      
     
  

14.      
    
     
   

15.     
     
  

16.     
  󰀨     
    

17. 
      
  
  

18.         
     
    
    
      
 

19.         
      
     

   

20. 
    
  
      

21.   
       

     

22.   
     


   

    
    
   



      
    
     
  
   
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   
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Atipik skuamoz hücrelerde kolposkopi/biyopsi
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The Prevalence of Different HPV Types in Turkish Women With a Normal Pap Smear
Article
Full-text available
  • Aug 2012
  • J MED VIROL
The age-specific human papillomavirus (HPV) seroprevalence and HPV type distribution in women with normal cervical cytology were studied. Cervical smear samples obtained using liquid-based smears from 582 clinically healthy women aged between 15 and 68 years from five centers from four different regions of Turkey, were studied between February 2010 and January 2011. Overall, 530 of the women with normal cytology were included and the samples were analyzed for the presence of HPV by AmpliTaq. Positive samples were typed further for 37 different HPV genotypes by a line blot assay. HPV was positive in 17.9% of the women. HPV prevalence was highest in the age group of 25-29 years (31.8%), and decreased with increasing age. HPV 16 was the most common type (3.6%) followed by type 6 (2.6%) and type 45 (2.2%). Types 11 and 18 were rare (0.6% and 0.4%, respectively). Among the risk factors, number of sexual partners and parity were positively correlated with HPV positivity. In the present study, a large number of sex partners and high parity increased the risk for HPV infection. The age-specific distribution of HPV in women with normal Pap smears did not show a U-shaped curve in contrast to European countries and the USA.
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Progression of CIN1/LSIL HPV Persistent of the Cervix: Actual Progression or CIN3 Coexistence
Article
Full-text available
  • Mar 2021
  • Infect Dis Obstet Gynecol
Objective: The natural history of the CIN1 lesions is characterized by an elevated rate of spontaneous regression (80%), some authors recognize a capacity to progress to HSIL in 10% of cases, and other authors do not recognize the capacity of progression of LSIL (CIN1). This study was aimed to evaluate the incidence of progression to HSIL (CIN3) in women with a histological diagnosis of LSIL (CIN1). Furthermore, to this end, we studied the histological outcomes of cone specimens collected by the LEEP. Methods: All the data were retrospectively analyzed. All participants underwent a follow-up of 4 years, during which each woman underwent an HPV test and genotyping, cervical cytological sampling, or biopsy every six months. The endpoint was the histological confirmation of CIN3 lesions in any moment during follow-up. Results: Progression to CIN3 occurred in 7 cases (1,5%). Analyzing the histological exams of the cones of the 7 cases that progressed to CIN3, we found the coexistence of CIN1 and CIN3 lesions in all cases. Conclusion: After 4 years of follow-up, only 1.5% (7/475) of the women with LSIL developed CIN3, all within the first two years of follow-up, and were immediately treated. The most likely explanations for "progression" from LSIL to HSIL are (1) actual progression, (2) underdiagnosis of HSIL on initial biopsy, (3) overdiagnosis of HSIL on follow-up biopsy/cone, and (4) CIN3 arose de novo. Analyzing the histological exams of the cones of the 7 cases that progressed to high-grade, we found the coexistence of CIN1 and CIN3 lesions in all cases. Some recent studies have shown that a viral genotype corresponds to different lesions in the same cervix; therefore, CIN1 coexisting with CIN3 does not always indicate progression of CIN1. Other authors have doubted the capacity of LSIL to progress.
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Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, Garcia FA, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS Jr, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ERAmerican 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 62(3): 147-172
Article
Full-text available
  • Apr 2012
  • AM J CLIN PATHOL
An update to the American Cancer Society (ACS) guideline regarding screening for the early detection of cervical precancerous lesions and cancer is presented. The guidelines are based on a systematic evidence review, contributions from 6 working groups, and a recent symposium cosponsored by the ACS, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology, which was attended by 25 organizations. The new screening recommendations address age-appropriate screening strategies, including the use of cytology and high-risk human papillomavirus (HPV) testing, follow-up (eg, the management of screen positives and screening intervals for screen negatives) of women after screening, the age at which to exit screening, future considerations regarding HPV testing alone as a primary screening approach, and screening strategies for women vaccinated against HPV16 and HPV18 infections.
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[Perspective of cervical cancer prevention and control in developing countries and areas]
Article
Full-text available
  • Jan 2010
  • Chin J Canc
Cervical cancer ranks the second common cancer in women, affecting women severely in developing countries. It is a critical issue to develop simple, rapid, accurate, safe, acceptable, and inexpensive screening tests which can be used in cervical cancer prevention programs in developing countries. Due to the shortage of funding and qualified cytological professionals in most developing countries, WHO has been actively promoting visual inspection with acetic acid/iodine solution (VIA/VILI) as the alternative approach to screening cervical cancer. After the discovery of a link between human papillomavirus (HPV) and cervical cancer, the HPV prophylactic vaccine and CareHPV test have been successfully developed. The cervical cancer will be the first cancer eliminated by the combination of vaccination, screening, early diagnosis and treatment.
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A Prospective Study of High-Grade Cervical Neoplasia Risk Among Human Papillomavirus-Infected Women
Article
  • Sep 2002
  • J NATL CANCER I
Background: In case-control studies, smoking, parity, and oral contraceptive use have been associated with an increased risk of cervical intraepithelial neoplasia grade 3 (CIN3) and cervical cancer among women who are infected with oncogenic human papillomavirus (HPV). However, these potential risk factors have not been adequately studied in prospective studies. Methods: We studied 1812 women who were enrolled in a 10-year prospective study of cervical neoplasia at Kaiser Permanente in Portland, Oregon, and who at enrollment had tested positive for oncogenic HPV DNA and had responded to a questionnaire that included questions on smoking, oral contraceptive use, and parity. Absolute risks and crude relative risks (RRs) with 95% confidence intervals (CIs) for CIN3 or cervical cancer were computed for three time intervals (0-8, 9-68, and 69-122 months after enrollment) using the Kaplan-Meier method. Conditional logistic regression models were used to control for factors that may have influenced our risk estimates, specifically the cytologic interpretation of baseline Pap smear, number of Pap smears during follow-up, age at enrollment, age at prediagnosis visit, and age at diagnosis. All statistical tests were two-sided. Results: Oral contraceptive use and parity were not associated with risk of CIN3 or cervical cancer. Former smokers, women who smoked less than one pack of cigarettes per day, and women who smoked one or more packs per day had crude RRs for CIN3 or cervical cancer for the entire follow-up period of 2.1 (95% CI = 1.1 to 3.9), 2.2 (95% CI = 1.2 to 4.2), and 2.9 (95% CI = 1.5 to 5.6), respectively, compared with never smokers. In the multivariable model, former smokers, women who smoked less than one pack/day, and women who smoked one or more packs/day had RRs of 3.3 (95% CI = 1.6 to 6.7), 2.9 (95% CI = 1.4 to 6.1), and 4.3 (95% CI = 2.0 to 9.3), respectively, for CIN3 or cervical cancer compared with never smokers. Conclusions: Smoking is associated with an increased risk of invasive cervical cancer in women who are infected with oncogenic HPV. Subsequent studies should examine the role of smoking in the multistage pathogenesis of cervical cancer.
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Human papillomavirus testing for the detection of high-grade cervical intraepithelial neoplasia and cancer: Final results of the POBASCAM randomised controlled trial
Article
  • Dec 2011
Human papillomavirus (HPV) testing is more sensitive for the detection of high-grade cervical lesions than is cytology, but detection of HPV by DNA screening in two screening rounds 5 years apart has not been assessed. The aim of this study was to assess whether HPV DNA testing in the first screen decreases detection of cervical intraepithelial neoplasia (CIN) grade 3 or worse, CIN grade 2 or worse, and cervical cancer in the second screening. In this randomised trial, women aged 29-56 years participating in the cervical screening programme in the Netherlands were randomly assigned to receive HPV DNA (GP5+/6+-PCR method) and cytology co-testing or cytology testing alone, from January, 1999, to September, 2002. Randomisation (in a 1:1 ratio) was done with computer-generated random numbers after the cervical specimen had been taken. At the second screening 5 years later, HPV DNA and cytology co-testing was done in both groups; researchers were masked to the patient's assignment. The primary endpoint was the number of CIN grade 3 or worse detected. Analysis was done by intention to screen. The trial is now finished and is registered, number ISRCTN20781131. 22,420 women were randomly assigned to the intervention group and 22 518 to the control group; 19 999 in the intervention group and 20,106 in the control group were eligible for analysis at the first screen. At the second screen, 19 579 women in the intervention group and 19,731 in the control group were eligible, of whom 16,750 and 16,743, respectively, attended the second screen. In the second round, CIN grade 3 or worse was less common in the intervention group than in the control group (88 of 19 579 in the intervention group vs 122 of 19,731 in the control group; relative risk 0·73, 95% CI 0·55-0·96; p=0·023). Cervical cancer was also less common in the intervention group than in the control group (four of 19 579 in the intervention group vs 14 of 19,731; 0·29, 0·10-0·87; p=0·031). In the baseline round, detection of CIN grade 3 or worse did not differ significantly between groups (171 of 19 999 vs 150 of 20,106; 1·15, 0·92-1·43; p=0·239) but was significantly more common in women with normal cytology (34 of 19,286 vs 12 of 19,373; 2·85, 1·47-5·49; p=0·001). Furthermore, significantly more cases of CIN grade 2 or worse were detected in the intervention group than in the control group (267 of 19 999 vs 215 of 20,106; 1·25, 1·05-1·50; p=0·015). In the second screen, fewer HPV16-positive CIN grade 3 or worse were detected in the intervention group than in the control group (17 of 9481 vs 35 of 9354; 0·48, 0·27-0·85; p=0·012); detection of non-HPV16-positive CIN grade 3 or worse did not differ between groups (25 of 9481 vs 25 of 9354; 0·99, 0·57-1·72; p=1·00). The cumulative detection of CIN grade 3 or worse and CIN grade 2 or worse did not differ significantly between study arms, neither for the whole study group (CIN grade 3 or worse: 259 of 19 999 vs 272 of 20,106; 0·96, 0·81-1·14, p=0·631; CIN grade 2 or worse: 427 of 19 999 vs 399 of 20,106; 1·08, 0·94-1·24; p=0·292), nor for subgroups of women invited for the first time (CIN grade 3 or worse in women aged 29-33 years: 102 of 3139 vs 105 of 3128; 0·97, 0·74-1·27; CIN grade 2 or worse in women aged 29-33 years: 153 of 3139 vs 151 of 3128; 1·01, 0·81-1·26; CIN grade 3 or worse in women aged 34-56 years: 157 of 16,860 vs 167 of 16 978; 0·95, 0·76-1·18; CIN grade 2 or worse in women aged 34-56 years: 274 of 16,860 vs 248 of 16 978; 1·11, 0·94-1·32). Implementation of HPV DNA testing in cervical screening leads to earlier detection of clinically relevant CIN grade 2 or worse, which when adequately treated, improves protection against CIN grade 3 or worse and cervical cancer. Early detection of high-grade cervical legions caused by HPV16 was a major component of this benefit. Our results lend support to the use of HPV DNA testing for all women aged 29 years and older. Zorg Onderzoek Nederland (Netherlands Organisation for Health Research and Development).
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Increased Risk of Oncogenic Human Papillomavirus Infections and Incident High-Grade Cervical Intraepithelial Neoplasia Among Smokers
Article
  • Apr 2009
  • SEX TRANSM DIS
The purpose of this study was to assess the effect of smoking on the prevalence and incidence of high-risk human papillomavirus (hr-HPV) infection and cervical intraepithelial neoplasia (CIN) in a large sample of Latin American women. The study examines baseline data on over 12,000 women included in the Latin American Screening Study (Brazil and Argentina), and over 1000 women followed-up for a period of 36 months. Three groups were formed: never smokers, current, and past smokers. The prevalence of hr-HPV infection and CIN were compared between the study groups. In the prospective analysis, women were controlled at 6-month intervals to assess the cumulative risk of incident hr-HPV infection, smear abnormalities, and CIN. A higher prevalence (21.7%) of hr-HPV infection was found among current smokers as compared to never smokers (16.5%) or past smokers (13.5%). Being current smoker was significantly (P <0.01) associated with hr-HPV detection (OR = 1.6; 95% CI = 1.2-2.1). Being a current smoker was a significant predictor of incident hr-HPV during the follow-up [Hazards ratio (HR) = 1.4; 95% CI 1.0-1.9]. For incident CIN2+, being a past smoker (HR = 3.6; 95% CI 1.6-9.8) or current smoker (HR = 3.6; 95% CI 1.5-8.6) were the significant independent predictors. Current and past smokers had a significantly increased risk of incident CIN2+ (P <0.01). Smoking increases the risk of contracting hr-HPV infection and modifies the effect of a persistent hr-HPV infection by further increasing the risk of developing CIN2+. It seems that this effect modification persists over several years after smoking cessation.
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