Eskişehir bölgesi’nde kadınlarda human papilloma virus (hpv) dna’sının iki farklı moleküler yöntemle araştırılıp tiplendirilmesi ve pap smear testi ile karşılaştırılması

Abstract

HPV enfeksiyonu, cinsel temasla bulaşan en sık hastalık olup; asemptomatik enfeksiyondan anogenital kansere kadar geniş bir klinik spektruma sahiptir. Serviks kanserlerinin %99’undan yüksek riskli HPV tipleri sorumludur. Bu araştırmada, Eskişehir Bölgesi’nde 30-65 yaş arası kadınların servikal örnekleri Pap smear ve iki farklı moleküler yöntemle çalışılmış, HPV prevalansı ve tip dağılımı belirlenmiş, üç yöntemin sonuçları birbirleri ile karşılaştırılmıştır. Araştırmaya dahil edilen 1081 kadından alınan servikal örneklerin 40’ı ASCUS (Atypical squamous cells of undetermined significance), 3’ü AGUS (Atypical glanduler cells of undetermined significance), 3’ü HGSIL (High grade squamous intraepithelial lesion), 1’i LGSIL (Low grade squamous intraepithelial lesion) olarak raporlanmış; 32 örnekte Hybrid Capture 2 (HC 2) ile HPV varlığı saptanmış, bunların 22’si yüksek riskli olarak belirlenmiştir. Pap testi sonucu pozitif olan servikal örneklerin 42’si (36 ASCUS, 3 AGUS, 2 HGSIL, 1 LGSIL) HC 2 ile negatifken; HC 2 ile yüksek riskli pozitif saptanan 19 örnek Pap testi ile negatif olarak raporlanmıştır. Rastgele seçilen 152 kadın grubunda ise konsensus Real-Time PCR ile 53 örnekte HPV DNA saptanmıştır. Bunların 32’si HC 2 ile de pozitif iken 21’i negatiftir. Örneklerden 5’i üç yöntemle de pozitif bulunmuştur. Pap testi sonucu pozitif olan 31 (27 ASCUS, 3 AGUS, 1 HGSIL) örnek konsensus Real-Time PCR ile negatif saptanırken; konsensus Real-Time PCR ile yüksek riskli ve/veya muhtemel yüksek riskli saptanan 28 örnek ise Pap testi ile negatif olarak değerlendirilmiştir. Eskişehir Bölgesi’nde en çok rastlanan genotipler sırasıyla; HPV tip 16, tip 90 ve tip 18 olmuştur. HPV’nin etiyolojideki önemi nedeniyle moleküler testlerin servikal kanser taramasında sitoloji ile birlikte kullanılması önerilmektedir. HPV ve serviks kanseri konusunda toplum bilinçlendirilmeli, aşı uygulaması ve tarama yöntemleri hedef gruba ulaştırılmalıdır.

HPV infection is the most common sexually transmitted disease and it has a wide clinic spectrum as the asymptomatic infection to the cervical cancer. High risk (HR) HPV types are responsible of 99% of cervical cancers. In this study, cervical samples of women between ages 30-65 were evaluated by Pap smear and two different molecular methods, and the prevalence of HPV and type distribution were determined, the results of three assays were compared with each other. Cervical samples obtained from 1081 women, ASCUS (Atypical squamous cells of undetermined significance) was reported in 40, AGUS (Atypical glanduler cells of undetermined significance) was reported in 3, HGSIL (High grade squamous intraepithelial lesion) was reported in 3, and LGSIL (Low grade squamous intraepithelial lesion) was reported in 1. HPV was detected in 32 samples by Hybrid Capture 2 (HC 2) and 22 of them were determined as HR HPV. In 42 of the samples that were positive with Pap smear, HC 2 was negative and 19 samples that were positive for HR HPV was negative by Pap smear. In other randomised group of 152 women, 53 samples were positive with consensus Real-Time PCR and 32 of them were positive by HC 2, but 21 of them were negative by HC 2. Five samples were positive by all of the three assays. In 31 samples that were positive by Pap test, consensus Real-Time PCR was negative. However, in 28 samples that were positive for HR and/or IR (intermediate risk) HPV by consensus Real-Time PCR, Pap test was negative. The most frequent genotypes were determined as; HPV type 16, type 90 and type 18 respectively, in EskiĢehir Region. Because of the importance of HPV at the cancer etiology it is recommended to use both cytology and molecular assays in cervical cancer screening. People should be awared of HPV and cervical cancer, and vaccination and cervical cancer screening programs should reach the target population.