Genotyping for HPV 16 and 18 in Women ≥50 Years of Age: Is It Useful?
Justin Peltola, Charanjeet Singh, Roberto Gamez, Samy Amirouche, Shelly Cook, Stefan E Pambuccian. University of Minnesota, Minneapolis
Background: Singnificant squamous cervical precursor lesions (CIN 2/3) and cervical squamous cell carcinoma are more commonly seen in women of reproductive age. However, due to a variety of hormonal and other factors, cytologic atypias are common in perimenopausal and postmenopausal women and may pose difficult management issues. Although HPV testing has been found to be useful in this patient population, the value of HPV genotyping, and in particular, testing for HPV16/18 is not well established.
The aim of this study was to identify the overall probability of having CIN 2/3 associated with HPV types 16 and 18 in women ≥50 years of age in comparison to women < 50 years of age.
Design: Our laboratory's records were searched for all women with liquid-based (Surepath) Pap tests (PT) with concomitant HPV genotyping data from January, 2001 – June, 2009. Women's age, cytologic diagnoses and HPV types identified were entered into a spreadsheet. The data was segregated into two major age groups, i.e. <50 and ≥50 years, and the follow-up biopsies obtained within 6 months of the Pap test diagnosed as CIN2/3 in both age groups were identified and further sub-classified into HPV 16/18 related and other high-risk HPV (31/33/35/39/45/51/52/56/58/59/68)-related CIN2/3.
Results: Of the 28,672 PT with HPV genotyping data identified during the study period, 5,418 PT were from women ≥50 years. 485 biopsies were done on hr-HPV+ women resulting in 30 diagnoses of CIN 2/3 in women with a PT diagnosis of NILM (n=1), ASC-US (n=17), LSIL (n=4), ASC-H (n=6) and HSIL (n=2). Of the 23,254 Pap smears performed in women under 50 years, 4,883 biopsies were done on hr-HPV+ women with 701 diagnoses of CIN 2/3. In the CIN 2/3 hr-HPV+ women under 50, 395 (56%) were positive for HPV types 16 or 18 while 306 (44%) were positive for other hr-HPV types. In the CIN 2/3 hr-HPV+ women over 50, 6 (20%) were positive for HPV types 16 or 18 while 24 (80%) were positive for other hr-HPV types.
|CIN 2/3 <50||CIN 2/3 ≥50|
|HPV, NON 16/18||306||24|