High-Risk Human Papilloma Virus (hrHPV) Positivity Rates with Histologic Correlation in Postmenopausal Women with Low Grade Squamous Intraepithelial Lesion (LSIL)
Gregory R Kotnis, Jinesh B Patel, Abha Goyal. Cleveland Clinic Foundation, Cleveland, OH
Background: There are several challenges inherent to the interpretation of the Papanicolaou (Pap) test in postmenopausal women, posing difficult management issues. The ASCCP acknowledges that reflex testing for hrHPV in postmenopausal women with LSIL is an acceptable option for colposcopic triage. However, there is limited data available regarding the follow-up of such patients based on their hrHPV results.
Design: A retrospective database search was conducted for the time period January 2008 to June 2011 for all cervical Pap tests (ThinPrep) with a diagnosis of LSIL or LSIL, high grade cannot be excluded (LSIL-H) in women ≥ 50 years of age (considered postmenopausal for the purposes of this study). The results of hrHPV co-testing (Hybrid Capture 2), if available, and histologic follow-up including colposcopic biopsy and/or endocervical curettage within the next 6 months, if any, were compiled. The two groups were compared using the chi-square test and a p value of < 0.05 was considered to be statistically significant.
Results: 384 patients were identified with LSIL during the study period, of which 246 were co-tested for hrHPV. Amongst these, 191 (78%) patients were hrHPV positive. 224 patients had histologic follow-up out of which 14 (6%) patients had CIN2 or above. LSIL-H was detected in 68 patients - 48 of these were co-tested for hrHPV out of which 44 (92%) were positive and 55 of these had histologic follow-up out of which 21 (38%) had CIN2 or above. None of the patients with a negative hrHPV result in either group were associated with CIN2 or above on follow-up. The differences between the rates of hrHPV detection and of subsequent high grade dysplasia on histologic follow-up in the LSIL and the LSIL-H groups were found to be statistically significant.
Conclusions: Our study reveals a high rate of hrHPV positivity (approximating the detection rate of the ASCUS/LSIL triage study of 82.9%) but a low prevalence rate of high grade squamous dysplasia in our postmenopausal patients with LSIL. The LSIL-H patients exhibited an even higher rate of hrHPV positivity and a much higher prevalence of high grade squamous dysplasia. These results indicate that reflex hrHPV testing has little potential value in LSIL-H patients and also question its utility in LSIL patients in this age group. Additional data that is more representative is needed to determine the most optimal option to guide clinical decision-making in this cohort.
Tuesday, March 20, 2012 1:30 PM
Platform Session: Section C, Tuesday Afternoon