Prisustvo patohistoloških premalignih lezija i infekcija visokorizičnim genotipovima humanih papilomavirusa kod bolesnica sa sumnjivim citološkim i kolposkopskim nalazima – prospektivna studija

Golubovic Mileta; Milena Lopičić; Nataša Terzić; Marija Djurović; Boban Mugoša; Gordana Mijović

doi:10.2298/VSP150205143G

Golubovic Mileta University of Montenegro, Medical Faculty, Clinical Centre of Montenegro, Centre for Pathology Podgorica
Milena Lopičić Center for Medical Microbiology, Institute of Public Health, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
Nataša Terzić Center for Medical Microbiology, Institute of Public Health, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
Marija Djurović Clinic of Gynecology and Obstetrics, Clinical Center of Montenegro, Podgorica, Montenegro
Boban Mugoša Center for Medical Microbiology, Institute of Public Health, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
Gordana Mijović Center for Medical Microbiology, Institute of Public Health, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro

DOI: https://doi.org/10.2298/VSP150205143G

Ključne reči: papillomaviridae||, ||papilloma virus, humani, uterine diseases||, ||materica, bolesti, uterine neoplasms||, neoplazme, vaginal smears||, ||vaginalni brisevi, histology||, ||histologija, primary prevention||, ||preventivno-medicinska zaštita,

Sažetak

Uvod/Cilj. Kod premalignih lezija grlića materice infekcija visokorizičnim genotipovima humanih papilomavirusa (HPV) može spontano biti eliminisana, opstajati ili dovesti do transformacije epitela grlića nižeg u viši stepen. Zato je važno pravilno odabrati bolesnice koje su u visokom riziku od obolevanja od karcinoma. Cilj studije bio je da se ustanovi međuzavisnost sumnjivog Papanikolau testa i kolposkopskog nalaza sa infekcijom visokorizičnim genotipovima HPV i prisustvom premalignih lezija grlića materice. Metode. U ovoj prospektivnoj studiji korištena je citološka, kolposkopska, lančana reakcija polimeraze (PCR) u realnom vremenu visokorizičnih genotipova HPV, kao i patohistološka analiza bioptata grlića materice. Istraživanje je obuhvatilo 2 578 žena u Kliničkom Centru Crne Gore, koje su upućene na citološku analizu tokom 2012, 2013, i 2014. godine. Posmatrano je 80 žena kojima je indikovana biopsija grlića materice zbog sumnjivog Papanikolau testa i atipičnog kolposkopskog nalaza. Rezultati. U grupi od 80 (3,1%; n = 80/2 578) odabranih bolesnica sa sumnjivim Papanikolau testom i kolposkopijom, njih 2/3 ili 56 (70%) bilo je sa cervicitisom, a 1/3 ili 24 (30%) sa cervikalnom intraepitelnom neoplazijom. Najčešće zastupljeni pojedinačni tip kod bolesnica sa cervikalnom intraepitelnom neoplazijom bio je HPV16 kod 8 bolesnica, tj. 61,53% od broja inficiranih ili 33,33% od ukupnog broja premalignih lezija. Zaključak. Kod bolesnica koje imaju sumnjiv Papanikolau test i kolposkopski nalaz i infekciju visokorizičnim genotipovima HPV (posebno HPV16) česta je pojava cervikalnih intraepitelnih neoplazija. U tim situacijama, obavezna je patohistološka provera lezije, kao odlučujući dijagnostički postupak.

Biografija autora

Golubovic Mileta, University of Montenegro, Medical Faculty, Clinical Centre of Montenegro, Centre for Pathology Podgorica

Prof. dr specijalista patolog

Reference

Steenbergen RD, Snijders PJ, Heideman DA, Meijer CJ. Clinical im-plications of (epi)genetic changes in HPV-induced cervical precancerous lesions. Nat Rev Cancer 2014; 14(6): 395−405.

Stanley M. Chapter 17: Genital human papillomavirus infec-tions--current and prospective therapies. J Natl Cancer Inst Monogr 2003; (31): 117−24.

Bosh FX. A scientific response to prevent cervical cancer in the world. Vaccine 2008; 26 Suppl 10: 5−6.

Kesic V. Methods for early detection (screening) of changes of the lower genital tract. In: Pijanovic P, editor. Colposcopy and diseases of feminine lower genital tract. Belgrade: Zavod za udzbenike i nastavna sredstva. 2000. p. 25−9. (Serbian)

Rovers Medical Devices B. V. Available from : http://roversmedicaldevices.com/index.php?pagina_id=9

Shiller W. Early diagnosis of carcinoma of portio uteri. Am J Surg 1934; 26: 130−1.

Rinku S, Vijayalakshmi B, Anupama J, Poonam C. A prospective study of 86 cases of ASCUS (atypical squamous cells of unde-termined significance) over two years. J Obstet Gynecol India 2007: 57(1): 73−6.

Horowitz IR. Improving the cost-effective evaluation and man-agement of atypical squamous cells of undetermined signifi-cance and low grade squamous intraepithelial lesions. Cancer 1998; 84(1): 1−4.

Ravic J. Importance of opportune systematic gynaecological examination in the early detection and prevention of premalignant and malignant cervical lesions [dissertation]. Novi Sad: University of Novi Sad Faculty of Medicine; 2006. (Serbian).

Tuskan E, Tyrolt B. Importance of systematic examination in the early detection of cervical carcinoma in Karlovac. Libri Oncol 1972; 1(4): 165−70. (Serbian)

Minic B, Jelesijevic M, Grujic S. Carcinoma of genital organs in area of women dispensary in Sabac for the period from 1971 to 1982. Proceedings of the 6th expert meeting of doctors from Podrin-Kolubaric area; Sabac. Sabac: Serbian Medical Society; 1983. (Serbian)

Ryerson A, Benard V, Major A. 1991-2002 National Report: Summarizing the first 12 years of partnerships and progress against breast and cervical cancer. Centers for Disease Control and Prevention; 2005. Available from : http://www.cdc.gov/cancer/nbccedp/Reports/NationalReport/index.htm . [accessed 2005. April 6].

Grcic R, Krajinovic S, Zivkovic J. Results of systematic examina-tions of women in some villages in Srem. Jug Ginek Opstet 1971; 11: 175−82. (Serbian)

Dillner J. Cervical cancer screening in Sweden. Eur J Cancer 2000; 36(17): 2255−9.

Bleggi TL, Werner B, Totsugui J, Collaço LM, Araújo SR, Huçulak M, et al. Cervical cancer screening program of Paraná: Cost-effective model in a developing country. Diagn Cytopathol 2003; 29(1): 49−54.

Bucchi L, Falcini F, Schincaglia P, Desiderio F, Bondi A, Farneti M, et al. Performance indicators of organized cervical screening in Romagna (Italy). Eur J Cancer Prevention 2003; 12(3): 223−8.

Sato S, Matsunaga G, Konno R, Yajima A. Mass screening for cancer of the uterine cervix in Miyagi prefecture, Japan: Effects and problems. Acta Cytol 1998; 42(2): 299−304.

Gottwald L, Giernat L, Lech W, Wójcik-Krowiranda K, Akoel KM, Kowalczyk-Amico K, et al. The results of screening program for cervical cancer in Lodz. Ginekol Pol 2002; 73(11): 934−8.

Giayetto F, Herrera A, Munoz D, Gomez S. The pilot screening program analysis for the early detection of uterine cervical cancer. Proceedings of the 10th World Congress of cervical pathology and colposcopy; Buenos Aires, Argentina; 1999 November 7−11; Abstract 133.

Bjørge T, Gunbjørud AB, Langmark F, Skare GB, Thoresen SO. Cervical mass screening in Norway: 510,000 smears a year. Cancer Detect Prev 1994; 18(6): 463−70.

Bjørge T, Gunbjørud AB, Langmark F, Skare GB, Thoresen SO. Mass screening for cervical cancer: A one-year registration of cervical cytological tests. Tidsskr Nor Laegeforen 1994; 114(3): 341−5. (Norwegian)

Nygård JF, Skare GB, Thoresen SØ. The cervical cancer screening programme in Norway, 1992-2000: Changes in Pap smear coverage and incidence of cervical cancer. J Med Screen 2002; 9(2): 86−91.

Kanno MB, Nguyen RH, Lee EM, Zenilman JM, Erbelding EJ. The prevalence of abnormal cervical cytology in a sexually trans-mitted diseases clinic. Int J STD AIDS 2005; 16(8): 549−52.

Lawson HW, Lee NC, Thames SF, Henson R, Miller DS. Cervical cancer screening among low-income women: Results of a na-tional screening program, 1991-1995. Obstet Gynecol 1998; 92(5): 745−52.

Anttila A, Nieminen P. Cervical cancer screening programme in Finland. Eur J Cancer 2000; 36(17): 2209−14.

Block B, Branham RA. Efforts to improve the follow-up of pa-tients with abnormal Papanicolaou test results. J Am Board Fam Pract 1998; 11(1): 1−11.

Burger RA, Monk BJ, Van NK, Greep N, Anton-Culver H, Manetta A. Single-visit program for cervical cancer prevention in a high-risk population. Obstet Gynecol 1995; 86(4 Pt 1): 491−8.

Raffle AE, Alden B, Mackenzie EF. Detection rates for abnormal cervical smears: what are we screening for. Lancet 1995; 345(8963): 1469−73.

Rodriguez GJ. Preventive program of cervical cancer in Uruguay. Proceedings of the Proceedings of the 10th World Congress of cervical pathology and colposcopy; Buenos Aires, Ar-gentina; 1999 November 7−11; Abstract 127.

Scheiden R, Wagener C, Knolle U, Wehenkel A, Dippel W, Capesius C. Cervical screening in Luxemburg: 1990-1999. Citopathology 2003; 14(5): 235−40.

Garnier A, Exbrayat C, Bolla M, Marron J, Winckel P, Billette VA. Campaign for cervical cancer screening with vaginal smears in women aged 50-69 years in Isère (France). Results of the first round (January 1991-June 1993). Bull Cancer 1997; 84(8): 791−5.

Institute for statistical and epidemiological cancer research. Statistics of mass screening activities cervical cancer screening. In: Pukkala E, editor. Finnish Cancer Registry, Helsinki, Finland: Institute for statistical and epidemiological cancer research; 2003. Avail-able from: http://www.cancerregistry.fi/eng/statistics/9-64-265.html

Chen CJ, You SL, Pwu RF, Wang LY, Lin YP. Community- based cervical cancer screening in seven townships in Taiwan. J Formo Med Assoc 1995; 94(Suppl 2): 103−11.

Ayinde AE, Adewole IF, Babarinsa IA. Trends in cervical cancer screening in Ibadan, Nigeria: A four-year review. West Afr J Med 1998; 17(1): 25−30.

Schaffer P, Sancho-Garnier H, Fender M, Dellenbach P, Carbillet JP, Monnet E, et al. Cervical cancer screening in France. Eur J Cancer 2000; 36(17): 2215−20.

Zhang D, Yang Y, Zhou L. Significance of DNA ploidy analysis in diagnosis of ASCUS. Zhonghua Fu Chan Ke Za Zhi 2012; 47(4): 259−62. (Chinese)

Massad SL, Behbakht K, Collins YC, Cejtin HE. Histologic find-ings from the cervix among older women with abnormal cer-vical cytology. Gynecol Oncol 2003; 88(3): 340−4.

Bucchi L, Falcini F, Schincaglia P, Desiderio F, Bondi A, Farneti M, et al. Performance indicators of organized cervical screenings in Romagna (Italy). Eur J Cancer Prevention 2003; 12(3): 223−8.

Institute for statistical and epidemiological cancer research. Statistics of mass screening activities: Cervical cancer screening. In: Pukkala E, editor. Finnish Cancer Registry, Helsinki, Finland: Institute for statistical and epidemiological cancer research; 2003. Available from: http://www.cancerregistry.fi/eng/statistics/9-64-265.html

ASCUS-LSIL Traige Study (ALTS) Group.Results of a randomized trial on the management of cytology interpretations of atypical squamous cells of undetermined significance. Am J Obstet Gynecol 2003; 188(6): 1383−92.

Patel TS, Bhullar C, Bansal R, Patel SM. Interpreting epithelial cell abnormalities detected during cervical smear screening: A cytohistologic approach. Eur J Gynaecol Oncol 2004; 25(6): 725−8.

Karateke A, Gurbuz A, Kabaca C, Zati A, Mengulluoglu M, Kir G. Atypical squamous cells: Improvement in cytohistological cor-relation by the 2001 Bethesda System. Eur J Gynaecol Oncol 2004; 25(5): 615−8.

Eltabbakh GH, Lipman JN, Mount SL, Morgan A. Significance of atypical squamous cells of undetermined significance on ThinPrep papanicolaou smears. Gynecol Oncol 2000; 79(1): 44−9.

Nyirjesy I, Billingsley FS, Forman MR. Evaluation of atypical and low-grade cervical cytology in private practice. Obstet Gynecol 1998; 92(4 Pt 1): 601−7.

Jordan J, Arbyn M, Martin-Hirsch P, Schenck U, Baldauf JJ, Da Silva D, et al.. European guidelines for quality assurance in cervical cancer screening: recommendations for clinical management of abnormal cervical cytology, part 1. Cytopathology 2008; 19(6): 342−54.

Planinic A, Lepej ZS, Bolaric B, Vargovic M, Grgic I, Gorenec I, et al. Detection of DNA high- risk genotypes of human papilloma virus with standardized PCR test in real time mode. Pro-ceedings of the 3rd Croatian congress on urogenital and sex-ually transmitted infections with international participation. Book of abstracts; 2011. May 20−22; Opatija, Hrvatska. Za-greb: Argenta d.o.o.. 2011. p. 85−6 (Croatian)

Crum CP, Mitam M, Levine RV, Silverstein S. Cervical papilloma-viruses segregate within morphologically distinct precancerous lesion. J Virol 1985; 54(3): 675−81.

Insinga RP, Dasbach EJ, Elbasha EH. Epidemiologic natural his-tory and clinical management of Human Papillomavirus (HPV) Disease: A critical and systematic review of the literature in the development of an HPV dynamic transmission model. BMC Infect Dis 2009; 9(1): 119.

Moscicki AB, Hills N, Shiboski S, Powell K, Jay N, Hanson E, et al. Risks for incident human papillomavirus infection and low grade squamous intraepithelial lesion development in young females. J Am Med Assoc 2001; 285(23): 2995−3002.

Bosch FX, Manos MM, Muñoz N, Sherman M, Jansen AM, Peto J, et al. Prevalence of human papillomavirus in cervical cancer: A worldwide perspective. International biological study on cervi-cal cancer (IBSCC) Study Group. J Natl Cancer Inst 1995; 87(11): 796−802.

Arbyn M, Dillner J. Review of current knowledge on HPV vac-cine: An appendix to the European Guidelines for Quality as-surance in cervical cancer screening. J Clin Virol. 2007; 38(3): 189−97.

Huang LW, Chao SL, Lee BH. Integration of human papilloma-virus type-16 and type-18 is a very early event in cervical car-cinogenesis. J Clin Pathol 2008; 61(5): 627−31.

Lungu O, Sun XW, Felix J, Richart RM, Silverstein S, Wright TC. Relationship of human papillomavirus type to grade of cervical intraepithelial neoplasia. JAMA 1992; 267(18): 2493−6.