Comparative Analysis of HPV DNA Test Utilization in Community and Colposcopy Clinics
A Plotkin, MA Khalifa, N Ismiil, V Dube, RS Saad, Z Ghorab, J Wong, G Desai, S Nofech-Mozes. Sunnybrook Health Sciences Centre, Toronto, Canada
Background: American Society for Colposcopy and Cervical Pathology (ASCCP) recommends testing for high-risk Human Papilloma Virus (HPV) DNA in women age 30 and older with an ASCUS result on their Pap smear. Accordingly, women are triaged for either colposcopy (positive HPV) or follow up (negative HPV). The purpose of this study was to compare trends in utilization of HPV testing between colposcopy and community clinic referrals from the time the test was implemented in our lab.
Design: All HPV DNA tests ordered between September '05 and December '08 in the department of Cytopathology were retrieved. HPV DNA was assessed on liquid base Pap smears using either Hybrid Capture II or PCR-based methodology (AMPLICOR® Roche) both directed to identify 13 high risk HPV types. Pertinent data regarding age, status of concurrent Pap smear and type of referral were collected from the medical records. The significance of the difference between the two independent proportions was tested using chi square test.
Results: Overall, 1,551 HPV DNA tests were performed during the study period, 699 (45%) of cases were requested by community clinics and 852 (55%) by colposcopy clinics. The proportion of women ≥30 was significantly higher in community clinic referrals 97.4% vs. 77% in colposcopy clinic referrals (p<0.0002). The most common setting for HPV testing in community clinic referrals was women ≥ 30 with ASCUS, accounting for 91.5% vs. 45.6% in colposcopy clinic referrals (p<0.0002). The proportion of SIL was significantly higher in colposcopy clinic referrals accounting for 30.6% of the requests compared with 4.1% in community referrals (p<0.0002). The proportion of positive cases was 27.7% in community clinic referral compared with 43.1% in colposcopy clinic referral (p<0.0002).
Conclusions: As expected from ASCCP practice recommendations, ASCUS in women ≥ 30 was the most common reason for the HPV DNA test requests in all referrals, but the nature of requests from colposcopy clinics were significantly different; characterized by higher proportion of women with evidence of dysplasia or younger than 30 and significantly higher positive tests. These findings are useful for health services planning as they uncover the trend of the broader test utilization beyond the existing recommendations.
Category: Gynecologic & Obstetrics
Tuesday, March 23, 2010 9:30 AM
Poster Session III # 171, Tuesday Morning