Uloga citologije u otkrivanju preinvazivnih i invazivnih promjena stidnice ovisno o načinu uzimanja uzorka

Scientific paper - Original scientific paper

• Title (english): The role of cytology in the detection of preinvasive and invasive vulvar changes depending of the sampling method
• Author: Ana Barišić
• Author: Joško Zekan
• Author: Vesna Mahovlić
• Author: Lada Škopljanac-Mačina
• Author: Sanda Rajhvajn
• Author: Danijela Jurič
• Author: Helena Lovrić
• Author: Joško Lešin
• Author: Damir Babić; MBZ: 168396
• Author's institution: University of Zagreb; School of Medicine; (Department of Pathology)
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pathology

Abstract (croatian)

Cilj: Eksfolijativna citologija stidnice kao neinvazivna metoda koristi se u dijagnostici i praćenju promjena na stidnici, osobito onih kod kojih nije indicirana biopsija. Dosad se tradicionalno obrisak uzimao špatulom te su citološki uzorci često bili slabo celularni. Kako bi se poboljšala celularnost uveden je postupak uzimanja endocervikalnom četkicom. ----- Materijali i metode: U retrospektivnoj studiji obuhvaćeno je 1866 uzoraka sa stidnice uzetih u razdoblju od 1. srpnja 2011. do 31. prosinca 2013. Analizirana je primjerenost uzoraka kao i omjer nalaza atipičnih pločastih stanica (ASC) prema nalazu pločaste intraepitelne lezije ili karcinoma (SIL+), ovisno o ambulanti u kojoj je uzorak uzet, te citohistološka korelacija.
----- Rezultati: U onkološkoj ambulanti specijaliziranoj za bolesti stidnice u kojoj je većina uzoraka uzimana četkicom bilo je najmanje neprimjerenih uzoraka zbog oskudnosti (3,4%), kao i zadovoljavajućih, ali oskudnih uzoraka (5,6%), a najviše ovakvih uzoraka bilo je u ginekološkim ambulantama primarne zdravstvene zaštite (13,7% odnosno 25,3%) u kojima su obrisci uglavnom uzimani na tradicionalan način – špatulom. Usporedili smo omjer ASC:SIL+ nalaza kod potpuno zadovoljavajućih nalaza ovisno o ambulanti u kojoj su uzeti uzorci: u ambulanti specijaliziranoj za bolesti stidnice bio je 2,6:1, u ostalim onkološkim ambulantama 1,9:1, u ostalim ambulantama klinike 3,5:1, dok je u ambulantama primarne ginekologije bio 2,3:1. Kod zadovoljavajućih, ali oskudnih nalaza ovaj omjer ASC:SIL+ varirao je od 5:1 do 11:0 ovisno o ambulanti u kojoj su uzorci uzeti. Citohistološka korelacija 159 slučajeva pokazala je visoku osjetljivost u otkrivanju preinvazivnih (94,1%) i invazivnih (100,0%) promjena, ali nisku specifičnost (35,4%). -----Zaključak: Uzorci sa stidnice uzeti endocervikalnom četkicom značajno su celularniji od uzoraka uzetih špatulom i time bolji za citološku analizu te je manji omjer ASC:SIL+ nalaza. Citološka analiza uzoraka sa stidnice ne može zamijeniti biopsiju, ali kod klinički nejasnih lezija može pomoći u postavljanju indikacije za daljnji postupak,
kao i u praćenju bolesnica s potvrđenom bolesti.

Abstract (english)

Aim: Exfoliative cytology of vulvar samples is used in diagnostics and follow up of vulvar changes, especially those in which biopsy is not indicated. Traditionally, samples were taken by spatula and the cellularity of the samples was low. To improve cellularity, taking samples by endocervical brush was introduced. ----- Material and methods: In the retrospective study 1866 vulvar samples taken in the period from July 1, 2011 to December 31, 2013 were analyzed. Cellularity of the samples, as well as the atypical squamous cells (ASC) to squamous intraepithelial lesion or carcinoma (SIL+) ratio, and the cytohistologic correlation were analyzed. ----- Results: In the vulvar disease specialized unit most samples were taken by endocervical brush, and the less unsatisfactory because of scantness samples (3.4%), as well as the satisfactory but scant samples (5.6%) were detected; the highest proportion of scant samples was detected in the outpatient gynaecology services(13.7% and 25.3%) where samples were taken traditionally by spatula. ASC:SIL+ ratio within fully satisfactory samples was the lowest in the other oncologic units(1.9:1), in the vulvar disease unit it was 2.6:1, in other clinic units it was 3.5:1, while in the outpatient gynaecology services it was 2.3:1. In the group of satisfactory but scant samples the ratio ASC:SIL+ was ranging from 5: 1 to 11:0 depending of the infirmary in which the samples were taken. Cytohistologic correlation in 159 cases was high in the detection of the
preinvasive (94.1%) and invasive (100.0%) lesions, but with low specificity(35.4%). ----- Conclusion: Vulvar samples taken by endocervical brush are significantly more cellular than the spatula taken samples, and cytologic interpretation of these samples is more adequate with lower ASC:SIL ratio. Cytologic vulvar samples cannot replace biopsy, but can be helpful in the patients with indistinctive lesions, or in controlling patients with confirmed disease.

• Keywords (croatian): TUMORI STIDNICE – patologija; STIDNICA – citologija, patologija; INTRAEPITELNE PROMJENE PLOČASTOG EPITELA – patologija; KARCINOM PLOČASTOG EPITELA – patologija; PREKANCEROZNE PROMJENE – patologija; OBRISAK RODNICE – metode; CITOLOŠKE TEHNIKE
• Keywords (english): VULVAR NEOPLASMS – pathology; VULVA – cytology, pathology; SQUAMOUS INTRAEPITHELIAL LESIONS – pathology; CARCINOMA, SQUAMOUS CELL – pathology; PRECANCEROUS CONDITIONS – pathology; VAGINAL SMEARS – instrumentation, methods; CYTOLOGICAL TECHNIQUES
• Language: croatian
• Language: english
• Publication type: Scientific paper - Original scientific paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Liječnički vjesnik
• Numbering: vol. 143, no. 1-2, pp. 6-13
• p-ISSN: 0024-3477
• e-ISSN: 1849-2177
• DOI: https://doi.org/10.26800/LV-143-1-2-2
• URN:NBN: urn:nbn:hr:105:299673
• Publication: 2021
• Document URL: https://hrcak.srce.hr/253809
• Type of resource: Text
• Access conditions: Open access
• Created on: 2021-04-21 11:58:22