Ocak 2013 - Nisan 2018 yılları arasında servikal biyopsi yapılan hastaların smear ve patoloji sonuçlarının değerlendirilmesi
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Dosyalar
Tarih
2019
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Çalışmamızda servikal biyopsi yapılan hastaların pap smear sonuçları ile patoloji sonuçlarının karşılaştırılması ve bu testler arasındaki korelasyonun araştırılması amaçlandı. Çalışmaya 1 Ocak 2013 ile 1 Nisan 2018 tarihleri arasında Trakya Üniversitesi Sağlık ve Araştırma Merkezi Kadın Hastalıkları ve Doğum Kliniği’ne başvuran ve muayenesi sonrası servikal örnekleme yapılan 623 olgu dahil edildi. Bu olguların gravida, parite ve yaş gibi verilerine ek olarak servikal smear, servikal biyopsi ve varsa operasyon patoloji sonuçları toplanarak veriler kaydedildi. İstatistiksel analiz SPSS 20.0 paket programında hesaplandı. Sonuçlar karşılaştırılıp anlamlı fark olup olmamasına göre rapor edildi. Olguların %55,4’sinde anormal smear, %27,1’inde anormal patoloji sonucu elde edildi. Hastaların ortalama gravidaları 3 ve pariteleri 2 olarak bulundu. Yaş ortalaması 46,2 ± 4,32 yıl olarak tespit edildi. HPV pozitif olgularda yaş ortalaması daha küçük olarak bulundu. Olguların smear sonuçlarının %43,6'sı ve biyopsi sonuçlarının %23,9’u enfeksiyon olarak yorumlandı. Olguların %37,3’ü ASCUS olarak değerlendirildiği için biyopsi yapıldı. En sık biyopsi nedeni ASCUS oldu. Biyopsi yapılan hastaların %10,4’ü CIN I olarak değerlendirildi. Olguların %22,4’üne (n=146) operasyon yapıldı ve en sık olarak %31,7’yle soğuk konizasyon uygulandığı görüldü. Operasyon sonuçlarında en sık olarak CIN I saptandı. Biyopsi yapılan olguların 50’si servikal invaziv karsinom olarak değerlendirilirken, opere edilen olguların 20’sinde servikal invaziv karsinom tespit edildi. Olguların biyopsi ve operasyon patolojisinde en sık skuamoz hücreli karsinom saptandı. Smear sonucunda %66,7’sinde anormal saptanırken, patoloji sonucunda bu oran %28,3 olarak saptandı. Olguların HPV durumları ile biyopsi patoloji sonuçları arasında anlamlı ilişki saptanmadı (p>0,05). Biyopsi sonucunda anormal saptanan %11,8 olgu, operasyon patoloji sonucuna göre normal olarak değerlendirildi (p<0,001). Biyopsi sonuçları normal olarak değerlendirilen ve klinik olarak şüphenin devam ettiği olguların %50’sinin operasyon patoloji sonucu anormal olarak değerlendirildi. HPV pozitif olan olgularda anormal patoloji, negatif olanlara göre daha fazla oranda saptandı (p<0,001). Smear sonucunda LGSIL durumuna göre operasyon patoloji sonuçlarında anlamlı farklılık görüldü (p<0,001). Yaş grupları arasında smear sonucu bakımından istatistiksel farklılık görülmedi. ASCUS olarak değerlendirilen olguların HPV varlığına göre patoloji sonuçları incelendiğinde istatistiksel olarak anlamlı sonuç bulunmadı (p>0,05). En sık tespit edilen HPV tipi HPV 16 olarak bulundu. Sonuçta smear testinin servikal invaziv kanser erken tanısında ne kadar önemli olduğunu ve bunun yanında yanlış negatif ve pozitifliklerin olduğunu gördük. Bu durumda yapılacak biyopsilerin smear testleri ile birlikteliğinde yanlış pozitiflik ve negatifliklerin azaltacağını, klinik şüphenin devam ettiği durumlarda bu şüphenin test sonuçları kadar göz önünde bulundurulması gerektiğini tespit ettik. HPV servikal patolojilerde önemli bir yer tutmaktadır. Çalışmamızda HPV pozitif olgularda, anormal smear ve anormal patoloji sonuçlarına daha fazla oranda rastlandığı tespit edilmiştir. Bu konuda alınacak önlemlerin, yapılacak erken tarama testlerinin ve daha fazla sayıda hasta içeren çalışmalardan elde edilebilecek sonuçların literatüre ve hastalara fayda sağlayacağını düşünmekteyiz.
The aim of this study was to compare the results of pap smear results with pathology results and to determine the correlation between these tests. 623 patients who applied to Trakya University Health and Research Center Gynecology and Obstetrics Clinic between January 1, 2013 and April 1, 2018 were included in the study. In addition to the data such as gravida, parity and age, cervical smear, cervical biopsy and, if any operation, pathology results were collected and the data were recorded. Statistical analysis was calculated by using SPSS 20.0 package program. Results were compared and reported for significant differences. Abnormal smear was found in 55.4% and abnormal pathology was found in 27.1% of the cases. The mean gravida was 3 and the parity was 2. The mean age was 46.2 ± 4.32 years. The mean age was smaller in HPV positive cases. The smear results of the cases were 43.6% and the biopsy results were 23.9% is cervical infections. Biopsy was performed as 37.3% of the cases were evaluated as ASCUS. The most common cause of biopsy was ASCUS. 10.4% of the patients who underwent biopsy were evaluated as CIN I. The operation was performed in 22.4% (n = 146) of the cases and cold conization was the most common with 31.7%. CIN I was the most frequent operation. Cervical invasive carcinoma was detected in 50 cases of biopsy and cervical invasive carcinoma in 20 patients of operation patology. Biopsy and surgical pathology were the most common squamous cell carcinoma. The rate of smear was found to be abnormal in 66.7% and the rate of pathology was found to be abnormal in 28.3%, respectively. There was no significant relationship between HPV status and biopsy pathology results (p> 0.05). As a result of the biopsy, 11.8% of the cases were found to be abnormal according to the surgical pathology (p <0.001). Biopsy results were evaluated as abnormal in 50% of the cases to the surgical pathology. In patients with HPV positive abnormal pathology was found to be more than the negative ones (p <0.001). Smear results showed a significant difference in the pathology results according to LGSIL (p <0.001). No statistically significant difference was found between the age groups in terms of smear results. When the pathology results of the cases evaluated as ASCUS according to the presence of HPV, no statistically significant result was found (p <0.05). The most common HPV type was HPV 16. In conclusion, we found that smear test is important in the early diagnosis of cervical invasive cancer and false negative and positive. In this case, we found that false positivity and negativity would decrease in the coexistence of biopsies with smear tests and this suspicion should be taken into account as much as the test results. HPV has an important place in cervical pathologies. In our study, we found that HPV positive cases were found to have a higher rate of abnormal smear and abnormal pathology, and that early measures and early screening tests would benefit the results and further comprehensive studies would benefit the literature and patients.
The aim of this study was to compare the results of pap smear results with pathology results and to determine the correlation between these tests. 623 patients who applied to Trakya University Health and Research Center Gynecology and Obstetrics Clinic between January 1, 2013 and April 1, 2018 were included in the study. In addition to the data such as gravida, parity and age, cervical smear, cervical biopsy and, if any operation, pathology results were collected and the data were recorded. Statistical analysis was calculated by using SPSS 20.0 package program. Results were compared and reported for significant differences. Abnormal smear was found in 55.4% and abnormal pathology was found in 27.1% of the cases. The mean gravida was 3 and the parity was 2. The mean age was 46.2 ± 4.32 years. The mean age was smaller in HPV positive cases. The smear results of the cases were 43.6% and the biopsy results were 23.9% is cervical infections. Biopsy was performed as 37.3% of the cases were evaluated as ASCUS. The most common cause of biopsy was ASCUS. 10.4% of the patients who underwent biopsy were evaluated as CIN I. The operation was performed in 22.4% (n = 146) of the cases and cold conization was the most common with 31.7%. CIN I was the most frequent operation. Cervical invasive carcinoma was detected in 50 cases of biopsy and cervical invasive carcinoma in 20 patients of operation patology. Biopsy and surgical pathology were the most common squamous cell carcinoma. The rate of smear was found to be abnormal in 66.7% and the rate of pathology was found to be abnormal in 28.3%, respectively. There was no significant relationship between HPV status and biopsy pathology results (p> 0.05). As a result of the biopsy, 11.8% of the cases were found to be abnormal according to the surgical pathology (p <0.001). Biopsy results were evaluated as abnormal in 50% of the cases to the surgical pathology. In patients with HPV positive abnormal pathology was found to be more than the negative ones (p <0.001). Smear results showed a significant difference in the pathology results according to LGSIL (p <0.001). No statistically significant difference was found between the age groups in terms of smear results. When the pathology results of the cases evaluated as ASCUS according to the presence of HPV, no statistically significant result was found (p <0.05). The most common HPV type was HPV 16. In conclusion, we found that smear test is important in the early diagnosis of cervical invasive cancer and false negative and positive. In this case, we found that false positivity and negativity would decrease in the coexistence of biopsies with smear tests and this suspicion should be taken into account as much as the test results. HPV has an important place in cervical pathologies. In our study, we found that HPV positive cases were found to have a higher rate of abnormal smear and abnormal pathology, and that early measures and early screening tests would benefit the results and further comprehensive studies would benefit the literature and patients.
Açıklama
Anahtar Kelimeler
Smear,, Patoloji, HPV, Pathology
