The Role of HRHPV Reflex Testing in the Triage of Peri- and Post-Menopausal Women with LSIL Pap Tests
Amber B Kernodle, Yasmin I Lutterbie, Wing-Keung Chiu, Megan J DiFurio. University of North Carolina School of Medicine, Chapel Hill, NC; University of North Carolina Women's and Children's Hospitals, Chapel Hill, NC; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
Background: Current management recommendations for women with abnormal Pap tests (ASCCP, 2006) include a new option for the management of post-menopausal women with LSIL, consisting of reflex high-risk HPV (HRHPV) testing. Despite this recommendation, HRHPV testing for the triage of LSIL Pap tests is still not routinely used by many practitioners. The objective of this study was to evaluate the relationship between HRHPV results and follow-up diagnoses, particularly for women of peri- and post-menopausal status.
Design: At UNC Hospitals, women ≥40 years old with LSIL cervicovaginal cytology results from 2004 to 2008 were identified. Patients with HRHPV testing and subsequent cervicovaginal sampling results (cytology and/or biopsy; most severe diagnosis) within 2 years were reviewed. Follow-up diagnoses obtained were categorized into high grade (i.e., HSIL and ≥CIN2/VAIN2) and low grade pathology. Age was dichotomized at 50 to examine the impact of peri- and post-menopausal status. Fisher's Exact test and Mantel-Haenszel statistics were used to test the relationship of age, HRHPV testing and pathology group. Odds ratio (OR) was used to describe the measures of association.
Results: Of 164 evaluable women, median age was 46. Patients with HRHPV negative results had significantly lower odds of having high grade follow-up pathology (OR=0.14, p=0.003) relative to those who were HRHPV positive. The association remained significant after controlling for age (p=0.003). Women ≥50 years with negative HRHPV had a significantly lower percentage of high grade pathology (0% or 0/24) than those with positive HRHPV (21% or 9/43, p=0.02).
|Age 40-49||Age ≥50|
|Low-Grade N (%)||High-Grade N (%)||Low-Grade N (%)||High-Grade N (%)|
|HRHPV Neg||28 (17)||2 (1)||24 (15)||0 (0)|
|HRHPV Pos||52 (32)||15 (9)||34 (21)||9 (5)|