Follow-Up Outcomes of Cytological and Histological Abnormalities among Women with Negative Computer-Imaged Liquid-Based Pap and Positive HPV DNA Test Results
C Zhao, RM Austin. Magee-Womens Hospital of UPMC, Pittsburgh, PA
Background: Limited data from the U.S. and overseas have been reported on the natural history of hrHPV positive women screened with negative conventional Pap smear results, but no reports have documented follow-up of cytology negative hrHPV positive women routinely screened with liquid-based cytology (LBC), computer-assisted screening, and HPV co-testing. The purpose of this study was to document the development of cytological and histological abnormalities among women who tested hrHPV positive along with negative Pap testing.
Design: The hospital records of MWH were searched for patients reported as negative on ThinPrep Imaging System-imaged ThinPrep Pap tests (TPPT) who also had positive HC2 hrHPV with co-test results between July 2005 and December 2007. Cytologic and histologic follow-up outcomes were analyzed.
Results: During the study period 402 women with negative TPPT and concurrent positive hrHPV results had documented cytologic and/or histologic follow-up. Histologic follow-up included 111 women who underwent cervical biopsy with or without ECC and 39 who underwent ECC alone. The mean age was 41.6 years (15-84 years). The average follow-up period was 13 months, ranging from 1 to 35 months (mean 10.6 m). Follow-up results documented that 8 of 402 (2.0%) women had tissue diagnoses of intraepithelial neoplasia 2+, including, four CIN2, two CIN3, one VAIN3, and one case of AIS with microinvasion. CIN1 was detected in 61 women(15.2%). 82 (20.4%) had follow-up ASC-US Pap test results. All CIN 2+ and 50 of 61 CIN 1 lesions were diagnosed based on histology. The interval between positive HPV/negative TPPT and diagnosis of CIN 2+ ranged from 1 month to 19 months (median 14 months).
Conclusions: CIN3, often proposed as a surrogate for invasive cervical cancer in cervical screening trials, was detected in 2 of 402 women (0.5%) with negative TPPT and concurrent positive HPV. Inclusion of two additional cases of histologically detected CIN2, one VAIN3, and one case of AIS with microinvasive endocervical adenocarcinoma potentially alters the risk profile of this cohort of over 400 cytology negative HPV positive patients. Additional natural history studies are needed on cytology negative HPV positive women routinely screened with modern methods which are now prevalent in the U.S. The potential benefits of routinely combining LBC and HPV co-testing for enhanced detection of endocervical neoplasia deserves special study, given the limited reported success of screening in this area to date.
Wednesday, March 11, 2009 9:30 AM
Poster Session V # 27, Wednesday Morning