Atypical Squamous Cells of Undetermined Significance in Patients with HPV Positive DNA Testing and Correlation with Disease Progression by Age Group: An Institutional Experience.
Erika F Rodriguez, Jordan P Reynolds, Sarah Jenkins, Michael R Henry, Aziza Nassar. Mayo Clinic, Rochester, MN
Background: Atypical squamous cells of undeterminated significance (ASC-US) is a broad diagnostic category that could be attributed to human papillomavirus infection (HPV), malignant neoplasia and reactive conditions. The aim of our study is to evaluate our institutional experience with ASC-US diagnosis in patients with a positive HPV test, and identify the risk of progression in association with age.
Design: We queried our inhouse database (SNOMED) for all patients with a diagnosis of ASC-US and HPV positive results by the digene hybrid capture method from 2005 to 2009. We reviewed cytologic and follow-up surgical pathology reports for all specimens available. Progression was defined as a diagnosis of at least CINI on follow-up cytology, biopsy or resection.
Results: We identified 2613 patients. Follow-up was available in 1839, 346 of which had progression at 60 days and were excluded. A total of 1493 patients were included for time-to-progression analysis, 79.2% had one follow-up, 13.9% had 2 total follow-ups, 4.2% had 3 follow-ups, and the remaining had as many as 6 follow-ups. The total days of follow-up from baseline ranged from 5 to 1905 days (median 289 days; IQR=182 to 508). The number of days from baseline to the first follow-up ranged from 3 to 1711 days (median 239 days; IQR=156 to 395). Among the 1493 patients, 68.7% were age 30 or younger, 15.9% were between 31 to 40, 9.7% were between 41 to 50, and 5.6% were 51 or older. Disease progression within different age groups are illustrated on Figure 1. Approximately 30% of patients >40 years-old progressed versus 25% in older age groups (>50). Overall, there is not significant difference in disease progression between the different age groups (p = 0.29).
Figure 1: Pathologic progression by age
Conclusions: Although HPV is a risk factor for cervical cancer, only a minority (25-30%) progressed to dysplasia on subsequent follow-up in our study population. It appears that there is no difference in progression in the different age groups. Therefore, follow-up is warranted in women with HPV-positive ASC-US, regardless of age.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 96, Tuesday Morning