Colposcopic Evaluation of Pre and Postmenopausal Women with Abnormal Cervical Cytologies

Yıl 2016, Cilt: 2 Sayı: 2, 14 - 19, 25.08.2016

Keziban Doğan , Hakan Güraslan

https://doi.org/10.19127/mbsjohs.76032

Cited By: 2

Öz

Objective: We aimed to evaluate the efficacy of conventional cytology on detecting precancerous lesions in postmenopausal women by comparing the results of colposcopic biopsies of the pre and postmenopausal women with abnormal cervical cytologies.    

Methods: Between January 2010 -December 2014 we reviewed patients who underwent colposcopic examination in clinic of obstetrics and gynecology of Bakirkoy Dr Sadi Konuk Teaching and Research Hospital retrospectively. The women were evaluated according to menopausal status, abnormal cervical cytologies and colposcopic examination results. NCSS (Number Cruncher Statistical System) for statistical analysis was used.

Results: Patient population (n=1658) was composed of 1289 premenopausal (77.7%) and 369 postmenopausal (22.3%) women. According to the results of cervical cytologies; benign Atypical squamous cells - unknown significance (ASCUS), Atypical squamous cells where a high-grade lesion cannot be eliminated (ASC-H) were not found statistically significant between two groups (p>0.05). Low-grade squamous intraepithelial lesion (LSIL); in premenopausal group, and high-grade squamous intraepithelial lesion (HSIL) in the postmenopausal group were found significantly higher (respectively p= 0.006; p = 0.002; p <0.01). When colposcopic results were evaluated; benign findings in postmenopausal women and cervical intraepithelial neoplasia (CIN) I in premenopausal women were found significantly higher (respectively, p = 0.001; p = 0.001; p <0.05). When postmenopausal patients with ASCUS cytology were evaluated, benign biopsy rate was significantly higher in colposcopy, on the other hand, CIN I ratio was significantly higher in premenopausal group with ASCUS cytology (p=0.007, p <0.01). When patients with LSIL were evaluated, benign biopsy rate in colposcopy was higher in postmenopausal patients, CIN I and CIN II-C III- Squamose cell carsinoma (SCC) rates were found in highly significant in premenopausal patients (p = 0.032; p <0.05).

Conclusion: When compared with the premenopausal patients group,         we have reached the conclusion that the conventional cytology has less efficiency in detecting the precancerous lesions            in postmenopausal cases; therefore, colposcopic examination may be appropriate in postmenopausal women. Routine liquid based cytology and HPV screening can achieve clarity in this debate, screening programs should be implemented effectively especially in postmenopausal group and further large scale studies are needed.

Anahtar Kelimeler

Cervical cytology, Menopause, Colposcopy, Precancerous cervical lesions

Kaynakça

• ASCUS-LSIL Triage 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: 1383–92.
• Bansal N, Wright JD, Cohen CJ, Herzog TJ.Natural history of established low grade cervical intraepithelial (CIN 1) lesions. Anticancer Res 2008; 28: 17-63.
• Dresang LT. Colposcopy: an evidence-based update. J Am Board Fam Pract 2005; 18: 383–92.
• Elter K, Durmusoglu F, Sezen D, Uygur M. The positive predictive value of annual cervical smears in postmenopausal women. Turkiye Klinikleri J Gynecol Obst 2004; 14: 311–6.
• Ferenczy A, Gelfand MM, Franco E, Mansour N. Human papillomavirus infection in postmenopausal women with and without hormone therapy. Obstet Gynecol 1997; 90: 7–11.
• Flynn K, Rimm DL. Diagnosis of‘ASCUS’ in women over age 50 is less likely to be associated with dysplasia. Diagn Cytopathol. 2001; 24: 132– 6.
• Jemal A, Tiwari RC, Murray T, Ghafoor A, Samuels A, Ward E. Cancer statistics, 2004. Cancer J Clin 2004; 54: 8–29.
• Keating JT, Wang HH. Significance of a diagnosis of atypical squamous cells of undetermined significancefor Papanicolaou smears in perimenopausal and postmenopausal women.Cancer . 2001; 93:100-105.
• Kobelin MH, Kobelin CG, Burke L, Lavin P, Niloff JM, Kim YB. Incidence and predictors of cervical dysplasia in patients with minimally abnormal Papanicolaou smears.Obstet Gynecol. 1998; 92: 356-359.
• Massad LS, Behbakht K, Collins YC, Cejtin HE. Histologic findings from the cervix among older women with abnormal cervical cytology. Gynecol Oncol. 2003; 88(3): 340–344.
• Massad LS, Einstein MH, Huh WK, et al.2012 updated consensus guidlines for management of abnormal cervical screening tests and cancer precursors. J Low Genit Tract Dis. 2013; 17: 1.
• Melnikow J, Nuovo J, Willan AR, Chan BK, Howell LP. Natural history of cervical squamous intraepithelial lesions: a meta-analysis. Obstet Gynecol. 1998; 92(4 Pt 2): 727-35.
• National Cancer InstituteWorkshop. The Bethesda System for reporting cervical/vaginal cytologic diagnoses: revised after second National Cancer Institute Workshop (April 29–30, 1991). Acta Cytol 1993; 37: 115–24
• Parkin DM, Bray F, Ferlay J, Pisani P: Global cancer statistics, 2002. CA Cancer J Clin 2005, 55:74-108
• Piccoli R, Mandato VD, Lavitola G, et al. Atypical squamous cells and low squamous intraepithelial lesions in postmenopausal women: implications for management. Eur J Obstet Gynecol Reprod Biol. 2008; 140(2): 269–274.
• Rohr LR: Quality assurance in gynecologic cytology. What is practical? Am J Clin Pathol 1990; 94:754-758
• Saad R, Dabbs D, Kordunsky L, et al. Clinical significance of cytologic diagnosis of atypical squamous cells, cannot exclude high grade, in perimenopausal and postmenopausal women. Am J Clin Pathol. 2006; 126(3): 381–388.
• Saad R, Kanbour-Shakir A, Lu Erxiong, Modery J, Kanbour A. Cytomorphologic analysis and histological correlation of high grade squamous intraepithelial lesions in postmenopausal women. Diagn Cytopathol. 2006; 34(7): 467–471.
• Sankaranarayanan R, Gaffikin L, Jacob M, Sellors J, Robles S: A critical assessment of screening methods for cervical neoplasia. Int J Gynaecol Obstet. 2005; 89: 4-12
• Sawaya GF, Grady D, Kerlikowske K, et al. The positive predictive value of cervical smears in previously screened postmenopausal women: the heart and estrogen/progestin replacement study (HERS). Ann Intern Med. 2000; 133(12): 942– 950.