Follow-Up Outcomes in a Large Patient Cohort with HPV-Negative ASC-H Computer-Imaged Liquid-Based Cytology (LBC) Results
David A Cohen, R Marshall Austin, Christopher Gilbert, Richard Freij, Chengquan Zhao. Magee-Womens Hospital of University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA
Background: Adjunctive HPV testing with co-testing-based risk stratification has become increasingly common. Current guidelines recommend a colposcopy referral for women with ASC-H cytology regardless of HPV status. To the best of our knowledge, no large follow-up data has been published in women with ASC-H cytology and negative HPV test results.
Design: Patients with ASC-H ThinPrep LBC and negative HC2 HPV test results were retrieved from our database between June 2005 and December 2010. Cytology specimens were screened with computer-assistance by the ThinPrep Imaging System (TIS). Cytologic, histopathologic, and repeat HPV test follow-up results were analyzed.
Results: 1049 negative hrHPV and ASC-H LBC cases were identified. Patients without repeat cytologic testing or histopathologic follow-up results in our database were excluded from the study leaving 912 patients with an average age of 37.4 years (17-89). The average follow-up period was 29 months (1-73). Histopathologic and cytologic follow-up results are shown in Table 1. Eighteen (2.0%) patients subsequently developed CIN2/3 or cytologic HSIL. 208 (22.8%) patients developed histopathologic CIN1 or cytologic LSIL.
The average time to diagnosis for CIN2/3 cases was 10 months (range 1-40). 384 (42%) patients had a Pap test as initial follow-up with an average interval of 10 months (1-57). 470 (51.5%) patients had repeat hrHPV testing of which 45 (9.6%) had hrHPV-positive results (Table 2). An initial repeat hrHPV test was positive in 35 of 470 (7.4%) of patients. The average follow-up interval to an initial repeat hrHPV test was 16 months (1-64) and 22 months (1-62) to an initial repeat positive hrHPV test. The average number of repeat hrHPV tests was 1.5 (1-6 range).
|Follow-up Method(s)||Total Cases||CIN2/3/HSIL#||CIN1/LSIL|
|HPV testing||Cases (%)|
|Positive only||26 (5.5)|
|Negative only||425 (90.4)|
|Both positive and negative||19 (4.1)|