ASC-H: HPV Status and Histologic Correlation Based on Age Distributions
SE Baker, B Yang, L Chen. Cleveland Clinic, Cleveland, OH
Background: ALTS study has shown that age distribution is an important factor in disease outcome and application of reflex HPV DNA testing results for ASCUS cytology. However, assessment of the impact of age distribution on disease outcome and on HPV testing on atypical squamous cells, cannot exclude HSIL (ASC-H) is limited in the literature. We reviewed our experience over the last 5 years on ASC-H cytology and correlated age distribution with HPV status and histopathologic followup in a large cohort study.
Design: All cases with cytologic diagnosis of ASC-H between February 2003 and December 2007 were retrieved from our pathology database. Results of reflex HPV tests using the Hybrid Capture 2 (HC-II) method were tabulated. Histopathologic diagnosis from either biopsy or LEEP specimen was reviewed, when available. The most severe histopathologic diagnosis was recorded and HPV test results were correlated with both cytologic and histopathologic diagnoses based on age distribution.
Results: Our patients with ASC-H had ages ranging from 16 to 88, with 42% women younger than 30 years and 58% older than 30 years. Among 648 cases diagnosed as ASC-H, 95.5% (619) had HR-HPV test results, including 36.5% HPV negative and 63.5% HPV positive. HPV positivity of ASC-H gradually decreased from 95% in women <20 to 36% in women >51 years. About 77% (497) of cases had histologic follow up. Correlation with histology revealed that CIN2+ lesions were found in 41% of all ASC-H cases. Approximately 92% CIN2+ cases were HPV positive and 8% were HPV negative. Among HPV negative CIN2+ cases, 25% were seen in women >51 and 62.5% seen in women >31 years. Accuracy in detection of CIN2+ by ASC-H gradually decreased from 58% in women <20 to 18% in women >51 years. The majority of postmenopausal women with ASC-H were HPV-negative with atrophic change.
Conclusions: The specificity of cytologic diagnosis of ASC-H for detection of CIN2+ lesions is good in young women, but significantly decreased in postmenopausal women due to atrophy. Reflex HPV testing on ASC-H cases has a sensitivity, specificity, and negative predictive value of 94%, 30% and 89% respectively in women <30 years, compared to 71%, 64% and 93% respectively in women >51 years. The majority of HPV negative CIN2+ lesions was seen in women older than 30 years.
Tuesday, March 10, 2009 1:15 PM
Platform Session: Section F, Tuesday Afternoon