[405] 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.

Table 1.Correlation of Follow Up Biopsy with HR HPV Results for ASC-H Pap Result

	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%)

N = number

Table 2. Correlation of Surgical Biopsy and HR HPV testing

	Biopsy Diagnosis
	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

Conclusions: While HR HPV testing may further triage ASC-H into low and high risk categories for progression to high grade cervical lesions, a significant proportion of ASC-H women (20%) with high grade lesions were negative for HR HPV in our study. A higher than expected false negative rate and lower than expected negative predictive value were noted. Thus, our findings support direct colposcopy and biopsy instead of triage of an ASC-H result with HR HPV DNA testing.
Category: Cytopathology

Tuesday, March 23, 2010 9:30 AM

Poster Session III # 68, Tuesday Morning