Servikal Patolojisi (Anormal Pap-Smear Sonucu Ya Da HPV Pozitifliği) Olan Hastaların Takibinin Değerlendirilmesi

Abstract

Cervical cancer is a quite suitable disease for screening and early detection because of its 99,7% association with HPV, having precursor lesions, cervix’s being easy to examine and cost-effectivity. In that way, our country has created a cervical cancer screening program. Patients with HPV 16-18 positivity or high-risk HPV positivity and abnormal Pap-Smear are referred to colposcopy center. Two studies were published about Republic of Turkey cervical cancer screening program’s effectivity with the analyzes of HPV positivity rates, smear results, colposcopy referral rates and unnecessary referral rates of 1 million women in 2018 and 4 million screened women in 2020. These two studies have shown that the program’s effective to the colposcopy referring step but has some heterogeneities about performing colposcopy. In the present study, a colposcopy evaluation form’s made for Cancer Control Department in the name of General Directorate of Public Health, Ministry of Health, Republic of Turkey. This form’s notified to colposcopy centers nationwide and wanted to be filled in for the patients having HPV 16-18 positivity or high-risk HPV positivity with abnormal Pap-smear. Punch biopsy, endocervical curettage and see and treat rates; adequacy of colposcopy and unnecessary colposcopy performing rates in 2018 February-2019 February were evaluated in both nationwide and NUTS region, by analyzing the forms. Although the study population is quite large, because of being a selected population as “the patients whose colposcopy evaluation forms were sent”, demographic outputs cannot reflect our country as high as the reference study’s reliability. HPV 16’s detected 29,5% (n=4062), while HPV 18 was %6,3 (n=872), HPV 31 was 8,2% (n=1132) and HPV 51 was 9,2% (n=1270). Our one visit screening with double triage strategy’s sensitivity, specificity, positive predictive value and negative predictive value was analyzed and its effectiveness with different triages were investigated. Comparison of different triage methods for ≥CIN-2 among the high-risk HPVs except HPV 16-18, revealed positive predictive value of 19,5% for only HPV 31 and 25% for only HPV 33. As a result of our study, 41,4% unnecessary colposcopy was performed; highly rates of punch biopsy were obtained, 79,9% (n=4455) in the group requiring colposcopy and 76,3% (n=2790) in the group not requiring colposcopy; the number of biopsies were mostly multiple biopsies, 69,5% (n=3068) in the required group and 63,7% (n=1742) in the nonrequired group. Endocervical curettage was performed highly rated, 57,1% in the required group and 53,2% in the nonrequired group. ≥CIN-3 lesions were detected 13,9% (n=616) in the group requiring colposcopy and 4,6% (n=130) in the nonrequired group. Some heterogeneities are seen on the basis of NUTS regions in both the data intended for evaluating the colposcopy performance and demographic one. However, when viewed globally, it was detected that cervical cancer screening program of Republic of Turkey has 82,5% sensitivity and 95,3% negative predictive value for ≥CIN-3 lesions. In this regard, additional studies are required to increase the sensitivity of the algorithm further and minimize the practice differences between regions with the cooperation of all relevant boards and organizations under the leadership of the Cancer Control Department.