[370] Follow-Up Outcomes of a Large Cohort of Low-Risk Women with ASC-US Imaged Liquid-Based Cytology and Negative HPV Test Results

Christopher Gilbert, Richard Freij, Arivarasan Karunamurthy, Zaibo Li, Chengquan Zhao. University Hospitals Case Medical Center, Cleveland, OH; Magee-Womens Hospital UPMC, Pittsburgh, PA

Background: New cervical screening guidelines propose a 5 year screening interval for the co-testing of women 30-65 years, and, for the first time, regard an ASC-US Pap test with negative high-risk (hr) HPV result (ANR) no different than a “double negative” (DNR) one. Long-term follow up data supporting this recommendation in the literature is very limited.
Design: We identified 6,852 patients 21 and older with ANR from computer-imaged ThinPrep and Hybrid Capture 2 hrHPV tests, screened between January 2006 and December 2006. 5 year follow-up data was collected from our laboratory information system including cytology, surgical, and HPV results. The follow-up diagnosis was assigned in decreasing order of significance: Cancer/CIN2-3/CIN1/Benign/HSIL/LSIL. Cytology diagnoses were selected only when no surgical pathology follow-up was available.
Results: Follow-up findings of CIN2/3/HSIL (HG) and CIN1/LSIL (LG) were detected in 1.3% and 7.8%, respectively. In women older than 30, HG was found in 26 of 4078 (0.55%), significantly lower than that in women 30 or younger (2.9%, 51/1766). No cases of invasive squamous cell carcinoma were identified. LG and HG results were detected in a significantly greater proportion of women with subsequent positive hrHPV results than in women with negative hrHPV results (60% vs. 5.4% p<0.001). The HG detection rate in women with ANR was significantly higher than that in women with DNR (0.3%, 12/4112, p<0.0001), but significantly lower than that in women with ASC-US and positive HPV testing (APR) results (5.1%, 111/2192, p<0.0001) in our institution.

5-year Follow-Up Findings after ANR Stratified by Age Group
 Total ANRWith Follow-UpLSIL/CIN1HSIL/CIN2/3
21-30 yr21431766 (82.4%)213 (12.1%)51 (2.9%)
31-40 yr17641497 (84.9%)106 (7.1%)13 (0.9%)
41-50 yr18731639 (87.5%)97 (5.9%)8 (0.5%)
51-60 yr838747 (89.1%)35 (4.7%)3 (0.4%)
>60 yr234195 (83.3%)3 (1.5%)2 (1.0%)
Total6852584445477



Conclusions: Our findings indicate that the risk of HG lesions in women with ANR is different from women with APR and women with DNR. That said, women older than 30 with ANR have a very low risk of CIN2+ lesions. This finding reaffirms the new recommendations by the United States Preventive Services Task Force and various professional societies.
Category: Cytopathology

Monday, March 4, 2013 1:00 PM

Poster Session II # 83, Monday Afternoon

 

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