[406] Age-Specific Histologic Follow-Up Findings for Women with High-Risk Human Papillomavirus – Positive "Low-Grade Squamous Intraelithelial Lesion" (LSIL) Papanicolaou Test Results

RG Gamez, M Roychowdhury, HE Gulbahce, B Thyagarajan, SE Pambuccian. University of Minnesota, Minneapolis, MN

Background: While most women with LSIL Papanicolaou test (PT) diagnoses are managed by immediate colposcopy, the ASCCP recently recommended the option to manage postmenopausal women with oncogenic (high-risk) HPV (hrHPV) triage. The aim of this study was to determine the age-specific likelihood of CIN2/3 in follow-up biopsies of women with hrHPV+ LSIL and further edvaulate the use of HPV16/18 genotyping in LSIL.
Design: All women with LSIL PT diagnosed from 04/01/2001 to 12/31/2008 with concomitant hrHPV-positive results who had histologic follow-up (cervical biopsy, cone/LEEP or hysterectomy) within 6 months of the index PT were identified through searches of the computerized databases of our institution, which serves a low-risk population. PCR-based HPV DNA testing was performed using the MY09/11 primers with genotyping by RFLP. HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68, included in the hc2 test were considered hrHPV.
Results: Of the 307 women with hrHPV+ LSIL results, 181 women aged 15-77 (mean 30+/-11) had follow-up histologic results (biopsy rate 59%). The biopsy rate was similar for women <30 or >=30 (113/195, 58% vs. 68/112, 60.7%, p=0.7). Follow-up biopsies showed 70 CIN1 (38.7%), 30 CIN2 (16.6%) and 20 CIN3 (11.1%) results. While the rate of CIN1 diagnoses did not differ with age, the rate of CIN2/3 diagnoses was significantly lower in women ≥30 (32.7% vs. 19.1%, p=0.047).

AgeNumber% CIN I% CIN2/3
<202437.537.5
20-298940.531.5
30-393839.523.7
40-492334.813.0
50-59633.316.7
>60100
all hrHPV+ <3011339.832.7
all hrHPV+ ≥306836.819.1


However, there was no difference between the rates of CIN2/3 in HPV16/18 women <30 and ≥30 (38.6% vs. 33.3%, p=0.62).

Age groupNumber%CIN I%CIN2
HPV16/18+ <307037.138.6
HPV16/18+ ≥303033.333.3


These differences were caused by higher rates of HPV16/18 in women <30 with LSIL as compared to women ≥30.
Conclusions: We found a significantly lower rate of CIN2/3 in follow-up biopsies of women ≥30 with hrHPV+ LSIL, explained by a lower prevalence of HPV16/18 in these women as compared to women <30. Our results suggest a role for HPV genotyping in women ≥30 with LSIL, since the presence of HPV16/18 appears to confer a similarly high risk of follow-up diagnoses of CIN2/3 as in younger women.
Category: Cytopathology

Monday, March 22, 2010 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 48, Monday Morning

 

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