High Risk HPV Detection and Follow-Up Findings in Women with Vaginal ASC-US Pap Tests
M Bansal, CZ Zhao. University of Pittsburgh Medical Center, Pittsburgh, PA
Background: Unlike the cervical smears, the role of High risk (hr)HPV testing in the triage of vaginal smears with ASCUS is not well known. The significance of hrHPV testing in women with vaginal ASC-US Pap test has very limited discussion in the literature. Most health organizations do not recommend cytologic screening of the vaginal cuff for most women with hysterectomy. In this study we analyzed vaginal ASC-US cases and correlate hrHPV status with histologic and Pap follow up (F/UP) findings.
Design: From our computer database, for a study period of 49 mths from July 2005 to July 2009, all the vaginal smears diagnosed with ASCUS and tested for hrHPV were retrieved. All Thin Prep Pap Test (TPPT) were prepared by an automated processor and imaged using Thin-prep imager. hrHPV detection was performed by Hybrid Capture 2 (HC2) method. F/UP results of biopsies and Pap tests were recorded. The most significant abnormality was recorded.
Results: A total of 1125 cases of vaginal TPPT were interpreted as ASCUS and also had hrHPV testing results. Of those, 244 cases (21.7%) were hrHPV positive, and 881 cases (78.3%) were hrHPV negative.138 hrHPV positive women had histologic and/or Pap F/UP results. Among hrHPV negative group, 379 cases were randomly selected to check the F/UP results, and 235 women had histologic and/or Pap F/UP results. The results are listed in the table 1. The study subjects were of an average age of 57yrs (20-91). F/UP period ranged from 0.2-44 months with a median of 22 months. Overall, VAIN 2/3/ HSIL (5.1%) and VAIN1/LSIL (42.8%) detection rates were significantly higher in hrHPV positive women than in hrHPV negative women (P<0.001). There was no statistically significant difference in VAIN detection between women ≤54 years and ≥55 years.
|Total||hrHPV Positive||hrHPV Negative|
|F/UP||F/UP NO.||LSIL-VAIN1*||HSIL/-VAIN2/3*||LSIL-VAIN1*/Total cases||HSIL-VAIN2/3*/Total cases||LSIL-VAIN1*/Total Cases||HSIL-VAIN2/3*/Total Cases|
|Cytology||302||27 (8.9%)||0||22/84 (26.2%)||0||5/218 (2.3%)||0|
|Histology*||71||42 (59.2%)||8 (11.3%)||37/54 (68.5%)||7/54 (12.9%)||5/17 (29.4%)||1/17 (5.9%)|
|Total||373||69 (18.5%)||8 (2.1%)||59/138 (42.8%)||7/138 (5.1%)||10/235 (4.3%)||1/235 (0.4%)|