[413] Frequency and Follow-Up Findings of Abnormal Cervical Cytology in Women ≥ 65 Years in a High-Risk Population

Kunle O Ojemakinde, Jaiyeola O Thomas. Louisiana State University Health Sciences Center, Shreveport, LA

Background: The 2009 ACOG guidelines for cervical screening recommend that the upper age limit for discontinuing screening be 65 or 70 years in those who have had ≥3 consecutive negative smears and no abnormal smear in the past 10 years; or have had total hysterectomy for non-cancer reason and no history of HSIL. This study reviews the abnormal cervical cytology findings in women ≥ 65 years to determine the disease burden in this age-group in a high-risk population.
Design: All abnormal cervical Pap smears (ASCUS, LSIL, ASC-H, HSIL, cancer) in women ≥ 65 years between January 2006 and June 2011 are extracted from the pathology data base and reviewed. Available follow up data of hrHPV profile, repeat cytology and histology are correlated with the abnormal findings.
Results: 145,144 Pap smears were received during the period with 5,700 (3.9%) from the target population (age range 65-89 years). 263 abnormal smears were identified from 209 women. Table 1 shows the distribution of abnormal cytology findings and corresponding biopsy/cytology follow-up. Of the 108 ASCUS index cases, 69 had HPV data with 26(37.7%) hrHPV+. Of the 13 ASCUS cases, carcinoma (3) and CIN2/3 (4) were diagnosed and invasive carcinoma in 14/48 cases (29.2%) with biopsy follow-up.

Distribution of Cytology Abnormality and Follow up Findings in Women More than 65 years
Index Cytology(No of Cases)Follow up CytologyHistologyhrHPV +VEhrHPV -VE
ASCUS(108)ASCUS10Atrophy226(37.7%)43(62.3%)
 LSIL2CIN14  
 ASC-H1CIN2/34  
 HSIL4Carcinoma3  
 AGC1    
 Carcinoma0    
 Total18Total13  
       
LSIL(49)ASCUS9CIN16  
 LSIL8CIN2/32  
 HSIL1Carcinoma1  
 Total18Total9  
       
ASC-H(10)  CIN112 
       
HSIL(25)LSIL1CIN12  
   CIN2/36  
   Carcinoma4  
 Total1Total12  
       
AGC(6)ASCUS1CIN12  
   CIN2/31  
   Carcinoma1  
 Total1Total4  
       
Carcinoma(11)  CIN34  
   Carcinoma5  
   Total9  



Conclusions: The study shows significant carcinoma detection rate (29.2%) and hrHPV+ ASCUS cases (37.7%) in those with follow-up. Cervical screening is still desirably in women ≥65 years in high-risk population.
Category: Cytopathology

Tuesday, March 20, 2012 2:30 PM

Platform Session: Section C, Tuesday Afternoon

 

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