Is HPV DNA Testing Useful for Women with LSIL Cytology?
A Heider, RM Austin, C Zhao. Magee-Women's Hospital of UPMC, Pittsburgh, PA
Background: Based primarily on ALTS data and ASCCP Guidelines, LSIL cytology is most often managed with colposcopic evaluation. Data on the efficacy of hrHPV triage and histologic follow-up of women with LSIL and HPV test results in different age groups remain limited.
Design: A computer-based search of Copath files of MWH, UPMC was carried out over a 34 month period (July, 2005 to April, 2008) to retrieve women reported to have LSIL who also were tested for hrHPV DNA. Pap tests were processed and prepared using an automated processor and imaged using the ThinPrep Imaging System. hrHPV DNA was detected by the HC2.
Results: 719 women with LSIL cytology and hrHPV DNA testing who had at least one subsequent cervical biopsy were included. The average follow-up period was 11 months (0 to 35 months) with a median 10.4 months. The interval between LSIL cytology and the initial histologic diagnosis of CIN 2/3 ranged from 1 to 29 months with a median 2.5 months. Either CIN 2/3 or CIN 1 were identified on histologic follow up in a significant greater proportion of LSIL women with positive hrHPV than in LSIL women with negative hrHPV (p=0.002 for CIN 2/3; p<0.001 for CIN 1). No CIN 2/3 was reported in women age 50 years or older with negative hrHPV test results. The percentage of CIN diagnosed on histology was not statistically significant between women with and without a TZ/ECS in their preceding LSIL cytology samples.
Table 1 Comparison of Histologic CIN between hrHPV Positive and Negative TPPT in LSIL Women Stratified by Ages* 1 case with CIN 3 and AIS
|hrHPV Positive||hrHPV Negative|
|Age||F/U No||CIN 2/3||CIN 1||F/U No||CIN 2/3||CIN 1|
|10-19||40||6 (15.0)||26 (65.0)||4||0 (0.0)||3 (75.0)|
|20-29||211||23 (10.9)||128 (60.7)||23||1 (4.3)||13 (56.5)|
|30-39||164||30 (18.3)||84 (51.2)||25||1 (4.0)||10 (40.0)|
|40-49||124||22* (17.7)||75 (60.5)||32||2 (6.3)||7 (21.9)|
|50-59||48||3 (6.3)||31 (64.6)||19||0 (0.0)||9 (47.4)|
|60||25||5 (20.0)||13 (52.0)||4||0 (0.0)||2 (50.0)|
|Total||612||89 (14.6)||357 (58.3)||107||4 (3.7)||44 (41.1)|
Conclusions: The absence of histologic CIN2/3 in women 50 years and older with hrHPV negative LSIL in this series supports that triage using hrHPV testing may be an efficient alternative to colposcopy in postmenopausal women with LSIL cytology in 2006 ASCCP consensus guidelines. hrHPV DNA results also help to stratify risk for underlying CIN2/3 in younger women and deserves further investigation along with other biomarkers for cervical carcinogenesis.
Tuesday, March 10, 2009 1:45 PM
Platform Session: Section C, Tuesday Afternoon