Reflex High Risk HPV Testing (HR HPV) Is Not Useful in Women with Atypical Squamous Cells – Can Not Exclude High Grade Squamous Intraepithelial Lesion (ASC-H)
GE Galliano, NA Moatamed, S Lee, N Salami, SK Apple. David Geffen School of Medicine, UCLA Medical Center, Los Angeles, CA
Background: ASC-H is a category created in the Bethesda 2001 and encompasses cells lacking the sufficient diagnostic features of HSIL. Current guidelines recommend immediate colposcopy with biopsy for follow up in patients with ASC-H. Recently a few small studies suggest that HR HPV DNA testing may also be used to triage patients with ASC-H. The aim of this study is to investigate if HR HPV testing in the ASC-H population identifies women at higher risk for high grade cervical neoplasia.
Design: We retrospectively identified all patients with a cervical cytology diagnosis of ASC-H within the consecutive 36 months between 2005 and 2007. Age, HR HPV DNA test results, and follow up cervical biopsy data were collected.
Results: During our study period, 192 patients with ASC-H (0.2%) were reported from a total of 92,111 Pap tests performed. The age of the patients ranged from 18 to 84 y (mean 34.2 y). From a total of 192 cases, 121 received follow up biopsy (63%). Eighty-two had reflex HR HPV testing (43%), and out of this group there were 53 with HR HPV testing and follow up biopsy (28%). Seven out of 12 patients who had ASC-H on Pap smear and were negative for HR HPV had HSIL on their biopsy (mean age 28.1 y). The positive predictive value of HR HPV positive in ASC-H cases for detection of HSIL is 68%. The negative predictive value of HR HPV negative for the absence of HSIL on biopsy is 42%. Sensitivity of the HR HPV test is 80% and specificity is 28% in ASC-H.
|Findings on Surgical Biopsy|
|HR HPV Results (N)||Negative||LSIL||HSIL|
|HR HPV + (41)||3 (7.3%)||10 (24.4%)||28 (68.3%)|
|HR HPV - (12)||3 (25%)||2 (17%)||7 (58%)|
|Total (53)||6 (11%)||12 (23%)||35 (66%)|
|LSIL and No Dysplasia||HSIL and greater||Total|
|HR HPV +||13 (32%)||28 (68%)||41|
|HR HPV -||5 (42%)||7 (58%)||12|
|Total||18 (34%)||35 (66%)||53|