Title (english) Pap Test – With or Without Vaginal Smear? Title (croatian) Papa test - Sa ili bez vaginalnog razmaza? Author Valerija Miličić-Juhas Author Marija Perić Author Marija Pajtler Author Ivana Prvulović Author Darko Čuržik Author's institution (Clinical hospital center Osijek) Author's institution Josip Juraj Strossmayer University of Osijek Scientific / art field, BIOMEDICINE AND HEALTHCARE Scientific / art field, BIOMEDICINE AND HEALTHCARE Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract (english) The aim of this study was to evaluate medical and economic justification of vaginal smears as a part of primary screening for cervical carcinoma and its precursors. Study included 245.048 participants whose VCE (vaginal, cervical, endocervical) smears were examined at Department of clinical cytology of University Hospital Center Osijek from 2003 till 2008. There were 12.639 (5.2%) abnormal findings, and they were divided into three groups: abnormal cells found only in vaginal smear (V), abnormal cells found in vaginal and in at least one other smear (V+) and abnormal cells not found in vaginal smear (C/E). These three groups were analysed in respect to cytological differential diagnosis and age of participants. It was estimated how many women could be additionally included in the screening, if vaginal smear would be included in the Pap test only after 50 years of age. In 6.9% of cytologically diagnosed lesions abnormal cells were found exclusively in vaginal smears (0.35% of all findings). As for squamous cell lesions, 91.2% were mild lesions (ASC and LSIL). Invasive squamous cell carcinoma was not diagnosed exclusively by vaginal smear in either woman under 50 years of age, while in women over 50 years of age it was diagnosed in 2.3% of cases. Exclusively by vaginal smear was diagnosed 3.9% of all AGC and 6.3% of adenocarcinoma, while in 85.0% of glandular epithelium lesions abnormal cells were not found in vaginal smears. Two thirds of adenocarcinoma diagnosed exclusively by vaginal smears were endometrial adenocarcinoma, but that is only 10.3% of all endometrial carcinoma diagnosed by Pap test. Obtained results show that taking of vaginal smears along with cervical and endocervical smears as a part of primary screening for cervical carcinoma and its precursors in women under 50 years of age is not justifiable, since vaginal smear only has a role in detection of endometrial carcinoma that are extremely rare in younger age groups. If vaginal smear would be taken only in women over 50 years of age, additional 37.7% of women under 50, or 25.1% women over 50 years of age could be included in the screening.
Abstract (croatian) Cilj ove studije bio je procijeniti medicinsku i ekonomsku opravdanost uzimanja vaginalnog razmaza u sklopu primarnog probira cervikalnog karcinoma i njegovih prekursora. U studiju je uključeno 245.408 ispitanica čiji su VCE (vaginalni, cervikalni, endocervikalni) razmazi bili pregledani na Odjelu za kliničku citologiju Kliničkog bolničkog centra Osijek od 2003. do 2008. godine. Abnormalnih je nalaza bilo 12.639 (5,2%), a podijeljeni su u tri skupine: abnormalne stanice nađene samo u vaginalnom razmazu (V), abnormalne stanice nađene u vaginalnom i bar u još jednom razmazu (V+) i abnormalne stanice nisu nađene u vaginalnom razmazu (C/E). Te su tri skupine analizirane u odnosu na citološku diferencijalnu dijagnozu i životnu dob ispitanica. Procijenjeno je koliko bi se `ena moglo dodatno obuhvatiti probirom ukoliko bi se vaginalni razmaz uključio u PAPA test tek nakon pedesete godine života. U 6,9% citološki dijagnosticiranih lezija abnormalne su stanice nađene isključivo u vaginalnim razmazima (0,35% svih nalaza). Kod lezija pločastog epitela u 91,2% slučajeva radilo se o lakšim lezijama (ASC i LSIL). Invazivni pločasti karcinom isključivo vaginalnim razmazom nije dijagnosticiran niti u jedne žene mlađe od 50 godina, dok je u žena starijih od 50 godina dijagnosticiran u 2,3% slučajeva. Isključivo vaginalnim razmazom otkriveno je 3,9% svih AGC i 6,3% adenokarcinoma, dok kod 85,0% lezija žljezdanog epitela abnormalne stanice nisu nađene u vaginalnim razmazima. Dvije trećine adenokarcinoma dijagnosticiranih isključivo vaginalnim razmazom čini adenokarcinom endometrija, no to je samo 10,3% svih PAPA testom dijagnosticiranih endometralnih karcinoma. Iz navedenih se rezultata može zaključiti da čenama mlađim od pedeset godina nema opravdanja uz cervikalni i endocervikalni uzeti i vaginalni razmaz u sklopu primarnog probira cervikalnog karcinoma i njegovih prekursora, budući da vaginalni razmaz ima ulogu jedino u detekciji endometralnih karcinoma koji su u mlađim dobnim skupinama izuzetno rijetki. Ukoliko bi se vaginalni razmaz uzimao samo ženama starijim od 50 godina moglo bi se dodatno pregledati još 37,7% žena mlađih od 50 godina, ili 25,1% žena starijih od 50 godina.
Keywords (english)
Adenocarcinoma / pathology
Age factors
Carcinoma, endometrioid / pathology
Carcinoma, squamous cell / pathology
Female
Health care costs
Humans
Mass screening / economics
Mass screening / methods
Middle aged
Neoplasms, glandular and epithelial / pathology
Uterine cervical neoplasms / pathology
Vaginal smears / economics
Vaginal smears / methods
Language english Publication type Scientific paper - Original scientific paper Publication status Published Peer review Peer review - international Publication version Published version Journal title Collegium antropologicum Numbering vol. 34, no. 1, pp. 69-74 p-ISSN 0350-6134 URN:NBN urn:nbn:hr:239:034920 Publication 2010 Document URL https://hrcak.srce.hr/51244 Type of resource Text Access conditions Open access Terms of use Created on 2020-05-21 10:09:23
