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[382] Follow up of High Risk Human Papillomavirus (HPV) Tests with High Viral Loads: Correlation with Original Pap Test Interpretations and Biopsy Results
Q Yuan, D Wilbur. Massachusetts General Hospital, Boston, MA
Background: Testing for HPV using the Hybrid Capture II method (Digene) includes an assessment of the amount of HPV DNA present in the sample via a relative light unit (RLU) determination. To ascertain if cases showing high (>1000) RLU values show differing follow up compared to all HPV test results, we analyzed high RLU tests and compared the results to published data.
Design: All HPV tests performed from Surepath (TriPath) Pap test vials with RLU values greater than 1000 were identified. In each case, the original Pap test interpretation and all biopsy follow up data was recorded. The percentages of follow up as negative, CIN I, and CIN II+ were calculated. These figures were compared to reported follow up data to determine if high viral load cases performed in a different manner.
Results: 156 cases were identified for study. 11 cases (7%) had no follow up and were excluded, leaving 145 cases. The cytologic interpretations of the corresponding Paps were: Negative (NILM) - 3(2%), ASC-US - 87(60%), ASC-H - 5(3%), LSIL - 40(28%), and HSIL - 10(7%). Biopsy follow up compared to the original cytologic interpretation is showed in the table below.
Table 1. Results of the Original Cytology and Biopsy Follow up for the High Risk HPV DNA Cases | Follow up Biopsy | | Original Cytology | Negative | CIN I | CIN II+ | | NILM | 3 (100%) | 0 (0%) | 0 (0%) | | ASC-US | 28 (32%) | 27 (31%) | 15 (17%) | | ASC-H | 1 (20%) | 2 (40%) | 2 (40%) | | LSIL | 7 (18%) | 25 (62%) | 8 (20%) | | HSIL | 1 (1%) | 2 (22%) | 7 (70%) |
Conclusions: In the ASCUS-LSIL Triage study (ALTS), all HPV+ ASC-US cases had a 26% chance of being CIN II+ on biopsy. In the present study, 17% of high RLU ASC-US cases were found to be CIN II+ on biopsy, which is very close to our own reported data (18%) previously. For ASC-H and HSIL cases, the present study showed that 40% and 70% of high RLU cases in these categories, respectively, had follow up of CIN II+, comparing very closely to ALTS and other studies. For LSIL cases, ALTS showed that 27% were CIN II+ on biopsy. In the present study, 20% of high RLU LSIL cases showed CINII+ on biopsy. This finding may represent a decline in CIN II+ as compared to ALTS, and may reflect a higher probability that high RLU cases are more likely to represent transient productive viral infections. Overall, however, the data from the study do not identify high RLU cases as significantly different from the overall HPV positive population, and therefore do not provide evidence for different management schemes.
Category: Cytopathology
Tuesday, March 27, 2007 9:00 AM
Platform Session: Section D, Tuesday Morning
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