[1185] Follow-Up Findings of Abnormal Vaginal Pap Tests from Post-Hysterectomy Women and Their Correlation with hrHPV DNA Test Results

Zaibo Li, Mona Bansal, Baoying Weng, Chengquan Zhao. Magee-Womens Hospital of UPMC, Pittsburgh, PA; Conemaugh Valley Memorial Hospital, Johnstown, PA

Background: Vaginal Pap tests are mainly performed in females with hysterectomy due to dysplastic/neoplastic lesions of genital tract. Abnormal vaginal Pap tests are managed in the same manner as abnormal cervical Pap tests; however, vaginal Pap tests differ in two respects: 1) they are obtained from elderly populations, 2) most patients have a history of dysplastic/neoplastic lesion.
Design: Vaginal ThinPrep Pap tests reported as ASC-US, ASC-H, LSIL, or HSIL with Hybrid Capture 2 (HC2) HPV DNA test were retrieved from our pathology database over 5 years period. Follow-up findings (histology and cytology) were analyzed and correlated with HPV test results.
Results: During the study period, 1,864 vaginal Pap tests were reported as ASC-US, ASC-H, LSIL, or HSIL with simultaneous HPV test results. The prevalence of HPV positivity and the age range are shown in Table 1.

HPV Test Results in Abnormal Vaginal Pap Tests

Abnormal Pap	Tested Cases	Positive Case (%)	Age, yrs (range)
ASC-US	1,614	365 (22.6)	56.7 (17 - 94)
ASC-H	49	29 (59.2)	58.6 (22 - 87)
LSIL	185	142 (76.8)	56.2 (27 - 92)
HSIL	16	13 (81.3)	62.6 (42 - 93)
Total	1,864	549 (29.5)	56.8 (17 -94)

A total of 779 women, including 333 HPV positive cases, had follow-up results with an average follow-up period of 16.2 months (0.5-94).

Follow-up results (histopathological and cytopathological)

	hrHPV positive			hrHPV negative
	Total F/U #	LSIL/VAIN1 (%)	HSIL/VAIN2/3 (%)	Total F/U #	LSIL/VAIN1 (%)	HSIL/VAIN2/3 (%)
ASC-US	214	93 (43.5)	8 (3.7)	401	18 (4.5)	2 (0.5)
ASC-H	21	14 (66.7)	2 (9.5)	17	4 (23.5)	1 (5.9)
LSIL	88	59 (67.5)	8 (9.9)	26	14 (53.8)	1 (3.8)
HSIL	10	2 (20)	7 (70)	2	1 (50)	1 (50)

Sensitivity, specificity, positive and negative predictive values (PPV and NPV) of HPV test for subsequently developed high-grade lesions were calculated.
Conclusions: 1. This is the largest study on HPV prevalence and subsequent follow-up results for post hysterectomy women with abnormal vaginal Pap tests.
2. The prevalence of HPV increased with increased degree of vaginal Pap abnormalities.
3. For ASC-US, ASC-H and LSIL, the NPV of HPV for the subsequent detection of CIN2/3/HSIL were very high (99.5%, 94.1%, and 96.2%).
4. HrHPV testing is a reasonable and cost-effective approach for women with vaginal ASC-US, even with ASC-H.
5. Patients with vaginal ASC-H or LSIL and negative hrHPV may be more efficiently managed by following up with Pap and HPV testing rather than colposcopy, especially for older women.
Category: Gynecologic & Obstetrics

Wednesday, March 21, 2012 1:00 PM

Poster Session VI # 187, Wednesday Afternoon