Long-Term Follow-Up of High-Risk HPV(+) Women over 30 with Concurrent Negative Liquid-Based Pap Test (LBPT, Surepath)
BA Schmitz, SC Schmechel, HE Gulbahce, X Wang, K Kjeldahl, SE Pambuccian. University of Minnesota, Minneapolis, MN
Background: The benefits of the currently recommended strategy of co-screening women > 30 with HPV and Pap tests (PT) are not yet fully known. The aim of this study was to assess the yield of significant cervical lesions (CIN2/3) of women with negative LBPT and a positive high-risk HPV test in a low-risk population screened with Surepath LBPT.
Design: We identified all women 30 with negative cytology and concurrent HPV DNA testing performed 2002-2007 on residual Surepath LBPT samples. HPV DNA was detected by PCR using MY09/11 probes and typed by RFLP. HPV+ women, regardless of HPV type, were age-matched with HPV(-) women. The following data were collected: presence of a transformation zone component (TZ), infectious organisms, previous recent abnormal PT, and follow-up PT, biopsies and HPV within up to 72 months (mean 36 months).
Results: 3,958 HPV tests were performed in women over 30. The overall HPV+ rate was 6.8% (268/3958). There was a decline in HPV(+) rates from 8.9% in women aged 30-34 to 3.5% in women 70. When only the hr-HPV types included in the Digene HC2 test were considered, there were only 2.5% hr-HPV+ women, and the corresponding decline in positivity for hr-HPV was 4% (30-34 years) to 0% (70 years). The 268 HPV+ and 268 age-matched controls had a mean age of 42 10.5 (range 30 to 86). The lack of TZ was not significantly different (22% vs. 25%) but HPV+ women had significantly more previous abnormal PT (37% vs. 14.5% OR=3.7 95% CI 2.4 to 5.6, p<0.001) and more infectious organisms (14% vs. 8% OR=1.9 95% CI 1.1 to 3.4, p=0.03). After a mean follow-up of 36 months, 59 women in the HPV+ group and 26 in the control group had cervical biopsies (OR=2.7 95%CI 1.7 to 4.4, p=0.0001). CIN1 was significantly higher in the HPV+ group (OR 9.5 95% CI 2.8 to 31.8 p<0.001) but rate of CIN2/3 were not statistically different between the two groups (p=0.06). HPV+ women with a previous abnormal PT had a significantly higher rate of biopsies of any abnormality and of CIN2/3 (OR=5.9 95% CI 1.2 to 28.99, p=0.03). Only 2 women without a previous abnormal PT results had CIN2-3 (1 CIN2, 1 CIN3).
Conclusions: Our results suggest that co-testing with HPV adds little to LBPT screening of women over 30. Of 3958 women with adequate HPV tests and negative concurrent LBPT, 6.8% were positive for any HPV (2.5% for hr-HPV), but only 9 CIN2/3 lesions were identified in this group after a mean follow-up of 36 months, and 7 of these women had a previous abnormal PT.
Monday, March 9, 2009 9:30 AM
Poster Session I Stowell-Orbison/Autopsy Award # 67, Monday Morning