[468] Outcomes in High-Risk HPV-Positive and HPV18/18-Positive Women with ASC-US Differ Based on the Women's Age Group

D Tasso, K Kjeldahl, SE Pambuccian, B Thyagarajan, HE Gulbahce. University of Minnesota, Minneapolis, MN

Background: By ASCCP guidelines, women with ASC-US on Papanicolaou tests (PT), undergo HPV DNA testing to determine high-risk HPV (hrHPV) infection. Colposcopy with biopsy is recommended for hrHPV+ patients. However, data on outcomes according to HPV genotyes and age are limited. The aim of this study was to determine the age-specific likelihood of CIN2/3 in follow-up biopsies of women with hrHPV+ ASC-US and further evaluate the use of HPV16/18 genotyping in ASC-US.
Design: We compiled cases of ASC-US with reflex HPV testing from 2003 to 2008. HPV infection was diagnosed by PCR using MY09/11primers and genotyping by RFLP. Follow-up biopsies up to 6 months from the index PT were included. The ASC-US diagnosis was made according to the 2001 Bethesda System. Women were divided into 2 groups by age, with 30 years as the cutoff.
Results: Of the 2910 women with hrHPV+ ASCUS, 1126 women aged 17-75 (mean 30+/-10) had follow-up histologic results (biopsy rate 38.7%). The biopsy rate was lower for women <30 than for those ≥30 (680/1852, 36.7% vs. 446/1058, 42.2%, p=.0039). Follow-up biopsies showed 371 CIN1 (33.0%), and 260 CIN2/3 (23.1%) results.

Table 1. Biopsy Follow-up on HPV16/18+ ASC-US Cases Stratified by Age

Age	No. F/U Biopsies	No. CIN1 on F/U (%)	No. CIN2/3 on F/U (%)
10-19	118	40 (33.9%)	43 (36.4%)
20-29	562	197 (35.1%)	138 (24.6%)
30-39	250	82 (32.8%)	51 (20.4%)
40-49	133	39 (29.3%)	20 (15.0%)
50-59	48	11 (22.9%)	6 (12.5%)
60-69	12	1 (8.3%)	2 (16.7%)
70-79	3	1 (33.3)	0 (0%)
Total	1126	371	260

While the rate of CIN1 diagnoses did not differ with age, the rate of CIN2/3 diagnoses was significantly lower in women ≥30 (26.6% vs. 17.7%, p=.0005). The rates of CIN2/3 in HPV16/18+ women <30 and ≥30 showed similar differences (133/415, 32.1% vs. 42/195, 21.5%, p=.0073).

Table 2. Follow-up of CIN 2/3 Detection Rate Among Younger and Older Women With HPV16/18+ and ASC-US

Age	No. F/u	CIN 2/3 (%)	P value
<30	680	181 (26.6%)	0.0005
≥30	446	79 (17.7%)	0.0073
TOTAL	1126	260

Conclusions: The rate of CIN2/3 diagnoses in hrHPV+ women of all ages with ASC-US was higher than reported by other similar studies (Armah et al. Arch Pathol Lab Med. 2009;133:1426–1430). Hr-HPV+ and HPV16/18+ women <30 with ASC-US had higher follow-up rates of CIN2/3. The role of HPV16/18 genotyping in women with ASC-US is uncertain and needs further studies.
Category: Cytopathology

Monday, March 22, 2010 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 57, Monday Morning