[1277] Liquid-Based Cytology and High Risk HPV Screening Test Histories Preceding 2827 Histopathologic Cervical Intraepithelial Neoplasia 2/3 Diagnoses

Chengquan Zhao, Milon Amin, Baoying Weng, Xiangbai Chen, Amal Kanbour-Shakir, Marshall R Austin. Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA; Conemaugh Valley Memorial Hospital, Johnstown, PA

Background: Cervical screening in the US increasingly involves newer FDA-approved cytologic methods and adjunctive HPV testing. Since the primary goal of cervical screening is to prevent cervical cancer by identifying and treating precancerous cervical lesions, we decided to carry out a large scale audit of screening test histories for women with established histopathologic CIN2/3 diagnoses.
Design: A computer-based search of our CoPath database was conducted over a study period of 65 months between July 2005 and November 2010 to identify patients with histopathologic CIN2/3 diagnoses. Preceding screening test histories for women screened with HC2 HPV testing and/or computer-imaged LBC ThinPrep Pap Tests were analyzed.
Results: 2827 patients with histopathologic CIN2/3 diagnoses were identified. The average patient age was 30.7 with a range of 16 to 91 years. Abnormal Pap tests ≤4 months before histopathologic CIN2/3 diagnoses were identified in 2074 of 2827 patients (Table 1). HSIL was the most common abnormal result (41.6%). Additional Pap test results, ≤ 3 years before histopathologic CIN2/3 diagnoses, were identified in 1488 patients (Table 2). Prior HPV results ≤4 months before CIN2/3 diagnoses were identified in 807 patients, with 97.4% hrHPV-positive. Additional HPV results, ≤ 3 years before CIN2/3 diagnoses, were identified in 454 patients. 83% patients had at least one positive HPV results, but 24.2% had at least one negative HPV result.

Abnormal Pap Test Results Proximate to Histopathologic CIN2/3 Diagnoses
Abnormal PapCase No%
HSIL86241.6
LSIL46422.4
ASC-US44521.5
ASC-H28813.9
AGC/AIS150.7
Total2074100




Prior 3 year-Pap Test History
Pap Results# Patients%
At least one abnormal smear97865.7
At least one normal smear91161.2
Both normal and abnormal smears40126.9
Total # patients1488100



Conclusions: 2074 of 2827 patients with histopathologic CIN2/3 had recent abnormal Pap results with HSIL in 41.6%. 97.4% of 807 patients with CIN2/3 diagnoses and recent hrHPV results tested hrHPV-positive, most often after reflex testing and ASC-US Paps. Among patients with additional screening tests ≤3 years before CIN2/3 diagnoses, a significant percentage of patients had negative Pap or negative HPV test results, consistent with rapid onset of at least some CIN2/3 lesions, inadequate sampling, or sensitivity issue of the tests. Our results support the value of co-testing in detection of small or inaccessible CIN2/3 lesions.
Category: Gynecologic & Obstetrics

Wednesday, March 21, 2012 1:00 PM

Poster Session VI # 188, Wednesday Afternoon

 

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