HPV Status and Histologic Follow up on Women with Cytologic Abnormality of ASC-H
SE Baker, L Chen, B Yang. Cleveland Clinic, Cleveland, OH
Background: Reflex HR-HPV testing for ASCUS has improved the specificity for detecting CIN lesions. However, studies examining the significance of reflex HPV testing on atypical squamous cells, cannot exclude HSIL (ASC-H) are limited. We reviewed our ASC-H cytology cases for the past 5 years to correlate ASC-H 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 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.
Results: Of a total 302,363 PAP tests performed, 648 cases (0.2%) were diagnosed as ASC-H cytologically. Of those, 619 cases (95.5%) had undergone reflex HPV testing and 497 (77%) had histopathologic diagnosis either by biopsy or by LEEP procedures. There were approximately 64% HPV positive and 36% HPV negative cases. Histopathologic examination revealed 42% benign cervix, 17% CIN1 and 41% CIN2+ lesions including 5 cases of AIS and 5 cases of invasive SCC. Of HPV positive cases, CIN2+ lesions were found in about 60% of cases, CIN1 in 19% and benign cervix in 21%. In contrast, among HPV negative cases, CIN2+ lesions were seen in about 8% of ASC-H cases, CIN1 in 12% and benign cervix in 80%. There is a statistically significant difference between the HPV positive and HPV negative groups both in detection of CIN 1-3 (P<0.0001) and CIN2+ lesions (p<0.0001). A total of 54 cases were diagnosed as ASC-H plus atypical glandular cells (44 AEC, 6 AGC and 4 AEM), which consists of about 68% HPV positive and 32% HPV negative. Followup study revealed 24 cases of CIN2+ including 2 AIS, 5 CIN1 and 24 benign cervix. CIN2+ lesions were found in 70% of HPV positive compared with 13% of HPV negative cases.
Conclusions: Reflex HPV testing has a high sensitivity (93%) in detection of high-grade cervical dysplasia among ASC-H patients. The odds ratio in detection of CIN2+ lesions is 8 times higher in HPV positive ASC-H than HPV negative ASC-H. Our study indicates that reflex HPV test significantly increases the specificity of high grade cervical dysplasia with cytologic diagnosis of ASC-H.
Monday, March 9, 2009 9:30 AM
Poster Session I Stowell-Orbison/Autopsy Award # 58, Monday Morning