An Investigation of Atypical Squamous Cells, Cannot Exclude HSIL (ASC-H) and Follow-Up Outcomes with Reflex HPV Testing
C Kelley, I Jovanovic, J Hy, I Check, L Liu. Evanston Hospital, NorthShore University HealthSystem, Evanston, IL
Background: The recommended management of women with ASC-H is immediate colposcopic examination without HPV testing. Our objective was to correlate HPV results in ASC-H cases with findings at colposcopy.
Design: 264 cases of ASC-H were identified from a total of 94,603 PAP tests performed between January 2007 and August 2008. Testing for high risk HPV had been performed in 103 cases and 39% were positive. Clinical follow-up included either colposcopy (172 cases) or a second PAP test (25 cases). 29 cases were lost to follow-up in our system. Biopsy results were categorized as negative, CIN 1, or CIN 2+; PAP results were graded as NILM, LGSIL, or HGSIL.
Results: In the 28 HPV+ patients who underwent colposcopy, 14% had CIN2+ lesions, 57% had CIN1, and 29% had negative biopsies. Of the 37 HPV- patients, none had CIN2+ lesions, 38% had CIN1, and 67% were negative. Of 107 patients who underwent colposcopy without HPV testing, 11% had CIN2+ lesions, 33% had CIN1, and 56% had negative biopsies. Of 25 patients who were followed only by repeat PAP testing, 8% had HGSIL, 8% had LGSIL, and 84% had NILM on follow-up. The study cohort was divided into 3 age groups: 18-35, 36-55, and over 55. All 4 of the CIN2+ lesions in HPV tested women occurred in the HPV+ group, 2 each in the younger groups None of the HPV- women had CIN2+ lesions, but a substantial number (36-40%) had CIN1 lesions. The proportion of CIN1 lesions was much greater in the HPV+ youngest women (71%), than in the 36 to 55 year-old group (40%),(p = 0.01).
Only 42% of the youngest women without HPV testing had negative biopsies compared to 73% of those 36 to 55 years old, and 55% of the oldest women. CIN2+ lesions were found in each age group (16%, 4.5%, and 15%, youngest to oldest, respectively). Although only 25 women with ASC-H were followed only by PAP smear, 84% of them had negative findings on subsequent testing.
Conclusions: The role of HPV testing in ASC-H is unclear. Biopsy of HPV+ cases is supported, because all CIN2+ cases occurred in that group. A negative HPV result is not associated with a high grade lesion; however, if these patients had not been biopsied, many CIN1 lesions would be missed.
Wednesday, March 11, 2009 9:30 AM
Poster Session V # 21, Wednesday Morning