Pap Tests with Both Atypical Squamous Cells of Undetermined Significance and Infectious Organisms in Liquid-Based (Surepath) Pap Tests: Impact on the Prevalence of Human Papillomavirus Infections and Follow-Up Biopsy Diagnoses
Sarah M Wilkins, Arbaz Samad, Jana L Holler, Gol Rahimaghaei, Samy A Amirouche, Stefan E Pambuccian. University of Minnesota Medical Center, Fairview, Minneapolis, MN
Background: Despite its use for more than two decades and the clearly formulated Bethesda system criteria, the diagnosis of atypical squamous cells of undetermined significance is still the most challenging and least reproducible diagnosis made on Pap tests. The diagnostic challenges can be exaggerated by the confounding effect of the reactive changes caused by infectious organisms (ORG). The significance of the association of ASC-US with infectious organisms has been controversial with some studies finding that the presence of ORG leads to an overcall of ASC-US, while others have shown an increased incidence of HPV detection in cases of ASC-US associated with ORG, especially Candida. The aim of this study was to determine the effect of infectious organisms (bacterial vaginosis (BV), Cadida (Cand) herpesvirus (HSV) and Trichomonas (TV)) on HPV rates and types in cases diagnosed as ASC-US on liquid-based (Surepath) Pap tests.
Design: We identified all cases diagnosed as ASC-US with concomitant infectious organisms (ASC-US+ORG) from 1/1/2003 to 12/31/2010 that had reflex HPV testing performed by a PCR-based method using MY09/11 consensus primers and typing by RFLP. The prevalence of any HPV type, high-risk HPV types (HR-HPV) and HPV16/18 and the frequency of abnormal follow-up biopsies diagnosed as CIN1 and above (CIN1+) and CIN2 and above (CIN2+) was compared to those of cases of ASC-US without associated organisms (ASC-US-ORG) statistically.
Results: Of the 23077 total ASC-US cases that fulfilled the study criteria, 2344(10.2%) were ASC-US+ORG (1015+BV, 1276+Cand, 23+HSV, 30+TV).
|AGE (MEAN±SD)||ALL HPV TYPES||HR-HPV TYPES||HPV TYPES 16/18||BIOPSY RATE||CIN1+||CIN2+|
|ALL ASC-US (N=23077)||36.3±13.2||8937 (38.7%)||4277 (18.5%)||1993 (8.6%)||4241 (18.4%)||1845 (8%)||581 (13.7%)|
|ASC-US-ORG (N=20733)||37±13.25||7625 (36.8%)||3624 (17.5%)||1703 (8.2%)||3701 (17.9%)||1593 (7.7%)||493 (2.38%)|
|ASC-US+ORG (N=2344)||30±10.7||1312 (56%)||653 (27.9%)||290 (12.4%)||540 (23%)||252 (10.8%)||88 (3.75%)|
|ASC-US+ORG VS. ASC-US-ORG %CHANGE||+52.2%||+59.4%||+50.6%||+29%||+39.9%||+57.9%|
|ASC-US+ORG VS. ASC-US-ORG p VALUE||<0.0001||<0.0001||<0.0001||<0.0001||<0.0001||<0.0001||<0.0001|