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.
|Total ANR||With Follow-Up||LSIL/CIN1||HSIL/CIN2/3|
|21-30 yr||2143||1766 (82.4%)||213 (12.1%)||51 (2.9%)|
|31-40 yr||1764||1497 (84.9%)||106 (7.1%)||13 (0.9%)|
|41-50 yr||1873||1639 (87.5%)||97 (5.9%)||8 (0.5%)|
|51-60 yr||838||747 (89.1%)||35 (4.7%)||3 (0.4%)|
|>60 yr||234||195 (83.3%)||3 (1.5%)||2 (1.0%)|