[399] Human Papilloma Virus Testing and p16 Immunohistochemistry as Ancillary/Reflex Tests in ASC-H Cervical-Vaginal Cytology

Sreeharsha N Masineni, Muhammad Zulfiqar, Tatyana Kalinicheva, Tamar Giorgadze, Sudeshna Bandyopadhyay, Hui Guan, Paul Tranchida, Dongping Shi, Shashi Madan, Vinod B Shidham. Wayne State University School of Medicine and Detroit Medical Center, Detroit, MI

Background: 'Atypical squamous cells – cannot exclude HSIL' (ASC-H) category in The 2001 Bethesda Terminology System continues to be a challenging area. The current ASCCP (American Society of Colposcopy and Cervical Pathology) guidelines recommend a colposcopic biopsy evaluation for ASC-H. As a part of IRB approved study at our tertiary care institution with extensive outreach component during the period of Jan 2010 to Aug 2011, we analyzed ASC-H interpretations in ThinPrep cervical cytology (TP) in relation to surgical pathology findings and results of Digene Hybrid Capture 2 High-Risk HPV DNA Test (HPVT).
Design: The database was searched for availability of surgical pathology (including p16 immunostaining) and HPVT for all ASC-H cases during this period. Positive predictive value (PPV) and negative predictive value (NPV) were calculated for HPVT & p16 with reference to surgical pathology results in ASC-H cases.
Results: We studied 754 TP with ASC-H from 722 patients with a mean age of 35.3 years. HPVT was available in 300 cases (115 with biopsy & 185 without biopsy). The results of surgical pathology including p16 and HPVT were analyzed (Table 1).

Table 1. Surgical biopsy, p16 IHC, and HPVT characteristics of cases with ASC-H
Total cases: 132446 (Over 20 months - Jan 2010 to Aug 2011) in TP
ASC-H Cases: 754
Biopsy (276 cases)HPVT with biopsy (115)p16 IHC with HPVT (28)p16 IHC without HPVT (35)
 P/Np16 - P; HPV - Pp16 - P; HPV - Np16 - N; HPV - Pp16 - N; HPV - NP/N
No Dysplasia - 142 cases (51%)11/5000160/12
CIN-1 - 58 cases (21%)13/14351110/0
≥CIN-2 - 76 cases* (28%)23/41140011/2*
CIN-1 includes both dysplasia and HPV changes. * Includes one case of endometrioid adenocarcinoma. P, positive; N, negative

Conclusions: 1. Although negative HPVT in ASC-H cases has a high NPV of 94% for HD in biopsy, an occasional case had false negative HPVT with positive HD in biopsy.
2. Comparable to ALTS recommendation for ASCUS, reflex HPVT is recommended as an adjunct to establish ASCCP type algorithm for managing the ASC-H cases.
3. p16 has a very high PPV of 100% for dysplasia in biopsies on ASC-H cases.
4. Although not evaluated directly during this study, based on the biopsy findings in this study and other reports related to the evaluation of p16 in liquid based cytology (both TP & SurePath), reflex application of p16 immunostaining on TP from residual sample is suggested.
Category: Cytopathology

Monday, March 4, 2013 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 56, Monday Morning


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