[394] Is There a Role for High Risk HPV Testing in the Triage of Patients with ASC-H?

Angelique W Levi, Akousa Domfeh, Kevin Schofield, Malini Harigopal, David Chhieng. Yale University, New Haven, CT

Background: Current guidelines recommend high risk (hr) HPV DNA testing for patients with atypical squamous cells, not otherwise specified (ASC-US) but immediate colposcopy for patients with ASC, cannot rule out HSIL (ASC-H). The objective of this study is to investigate the role of hrHPV testing for colposcopy triage of ASC-H in routine practice, as there are no guidelines for its use in this setting.
Design: All liquid based Pap tests with the diagnosis of ASC-H were identified between Jan 2008- December 2011. hrHPV DNA testing either as cotesting or reflex testing was performed using hybrid capture II (Qiagen, Gaithersburg, MD). Patient demographics and results of histologic follow up were recorded.
Results: During the study period, a total of 630 Pap tests were diagnosed with ASC-H, accounting for 0.2% of all Pap tests evaluated during the study period. ASC-H accounted for 0.17% of all SurePath and 0.33% of all ThinPrep specimens; the difference was statistically significant. High risk HPV status was available in 586 (93%) cases; 396 (67.6%) were tested for hrHPV. Table 1 and 2 summarize the results of follow up according to hrHPV status, specimen type and two different age groups (< 30 vs ≥ 30). There were no statistically significant differences in the percentage of patients found to have a CIN2+ lesion with a negative hrHPV status between the two types of liquid based preparations or between the two different age groups.

Table 1.
hrHPV Negative Cases
Follow-up SP DiagnosisNegative/CIN 1 (%)CIN 2+ (%)No FU (%)Total
<30 years60.428.3331.2585
≥30 years90.487.621.90105
Total65.267.3727.37190 (of 586)

Table 2.
hrHPV Positive Cases
Follow-up SP DiagnosisNegative/CIN 1 (%)CIN 2+ (%)No FU (%)Total
< 30 years37.8441.0821.08185
≥ 30 years62.2337.770.00211
Total47.2237.3715.40396 (of 586)

Conclusions: The incidence of ASC-H diagnoses was low for both liquid based preparations but the incidence of ASC-H of ThinPrep specimens was significantly higher than that of SurePath. hrHPV was positive in about 2/3 of the patients with ASC-H. 8% or less of patients with ASC-H and a negative hrHPV status were found to have a CIN2+ lesion. High risk HPV DNA testing is useful in triaging patients with a diagnosis of ASC-H regardless of the preparation type or age group.
Category: Cytopathology

Monday, March 4, 2013 1:00 PM

Poster Session II # 92, Monday Afternoon


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