HPV Testing of LSIL-H: Is There Any Correlation with Positive Predictive Value for HSIL?
AN Sireci, A Saqi. New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
Background: The diagnosis of low-grade squamous intraepithelial lesion (LSIL), cannot rule out high-grade squamous intraepithelial lesion (HSIL) or LSIL-H is rendered in cases with unequivocal LSIL and rare atypical squamous cells, cannot exclude high-grade lesion (ASC-H). The LSIL-H diagnostic category is not recognized by the 2006 Bethesda Guidelines but is used in cytopathology practice. The positive predictive value (PPV) of LSIL-H for HSIL has been shown by previous reports to be intermediate between LSIL and HSIL and similar to ASC-H. However, only a rare study has evaluated the impact of human papilloma virus (HPV) DNA testing on the PPV of LSIL-H for HSIL. The goal of the current study was to determine whether HPV testing of LSIL-H diagnoses can improve the PPV for high grade lesions.
Design: All cases with the diagnosis of LSIL-MORE/LSIL-H (n=300), histological and/or cytological follow-up within one year (n=220), and hybrid capture 2 HPV testing (n=90) spanning a 36-month period were retrieved. P-values were determined using the ANOVA test statistic.
Results: The PPV of LSIL-H for a high grade lesion on either histological or cytological follow-up was 16.4%.
Follow-up diagnoses after initial LSIL-H
|Diagnosis n=220||Percentage (n)|
Eighty percent of LSIL-H diagnoses were HPV(+). When stratified by diagnostic category, a higher proportion of patients with subsequent HSIL diagnosis were HPV(+) (92.3%) compared to those with either LSIL (85.7%), ASCUS (81.8%) or negative (71%) follow up; the difference, however, was not statistically significant.
HPV positivity by follow-up diagnosis
|Follow-up Diagnosis n=90||% (n)||% HPV+ (n)||P-value|
|HSIL||14.5% (13)||92.3% (12)||p=0.301|
|LSIL||31.1% (28)||85.7% (24)|
|ASCUS||12.2% (11)||81.8% (9)|
|NEGATIVE||42.2% (38)||71.0% (27)|
Conclusions: Although a large majority of our LSIL-H cases are positive for high-risk (HR)-HPV, they do not correspond to a higher grade lesion on follow-up. Testing for HR-HPV therefore does not appear to improve the PPV of LSIL-H for high grade follow-up lesions. Furthermore, we conclude that patients with LSIL-H should be managed like patients with LSIL as the majority of cases result in low-grade or negative follow-up.
Wednesday, March 11, 2009 9:30 AM
Poster Session V # 34, Wednesday Morning