[1192] Should High-Risk Adolescents Have Pap Tests?

Ly T Ma, Gwyn Richardson, Reagan M Street, Vicki J Schnadig. University of Texas Medical Branch, Galveston, TX

Background: The 2009 ACOG guidelines state that cervical cancer screening (CCS) commence at age 21-years owing to a very low incidence of cervical carcinoma in this age group and the potential for harmful follow-up treatment. Our institution serves a large population of high-risk adolescents (HRA), with early onset of sexual activity and pregnancies. We investigated outcomes and demographic data of HRA with HSIL Pap tests in order to identify any subgroups who may benefit from CCS.
Design: Computer-based search for years 2000-10 was done to identify Pap results from women under 21-years-old. Chart review of women with at least one HSIL Pap test was done to obtain biopsy and LEEP results and sexual and pregnancy history when available.
Results: Of 56,785 adolescent Pap tests, 45,276 (79.5%) were negative, 11,232 (20%) were ASCUS or LSIL and 277 (0.5%) were HSIL; Of the HSIL group, 89 (32%) had no biopsy, 35 (13%) had no dysplasia on biopsy, 57 (21%) had CIN 1, 40 (14%) had CIN 2, and 56 (20%) had CIN 3. One case of microinvasive cervical carcinoma (MIC) was found on LEEP.

Adolescent Demographic Data

Grade	No. Lifetime Partners (n)	Age of First Intercourse (n)	Age of First Pregnancy (n)
CIN 1/No Dysplasia on Bx	3 (9)	16 (8)	18 (6)
CIN 2	4 (10)	18 (11)	18 (6)
CIN 3/MIC	7 (14)	15 (15)	17 (9)

No differences in demographic data were statistically significant between any subgroups.
Conclusions: Our rate of HSIL in adolescents was 0.5%, consistent with other studies. However, our study did find 56 (20%) CIN 3 lesions in the HSIL subgroup. CIN 3 behavior in adolescents has not been well described, but current guidelines from ACOG and the ASCCP states that CIN 3 lesions in adolescents should be ablated. This subset of adolescents was detected by cervical cancer screening and, in line with current guidelines, was treated with ablation. This study shows that the ACOG guidelines for adolescents may be reasonable for the majority of the adolescent population, but a subset of HRA with CIN 3 would be not be detected. The demographic data failed to identifiy a subgroup of adolescents at higher risk for CIN 3. We cannot suggest a way to select out the high-risk adolescents that would require CCS. Because there is a subset of HRA with CIN 3 lesions, we feel that more study is needed to create a process that can select out these high-risk adolescents for CCS.
Category: Gynecologic & Obstetrics

Monday, March 19, 2012 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 168, Monday Morning