Discordant Pap Tests (HPV Positive Cytology Negative Cotests): A Follow-Up Study of 334 Patients
Olaronke O Oshilaja, Jordan P Reynolds, Abha Goyal. Cleveland Clinic Foundation, Cleveland, OH
Background: As per current ASCCP (American Society for Colposcopy and Cervical Pathology) guidelines, women with HPV positive and cytology negative cotests should either undergo repeat cotesting after 12 months or reflex genotype-specific testing for HPV 16 or HPV 16/18. Immediate colposcopy is not recommended in this cohort of patients, unless they test positive for HPV 16 or HPV 16/18. These guidelines have been revisited recently in 2012. In this study, we examine how far these guidelines have got integrated into our practice and whether the current management strategy appears to be justified.
Design: A retrospective database search was conducted at our institution for the year 2010 to identify women ≥ 30 years of age with Pap tests with negative cytology and positive HPV cotesting results. Clinicopathologic data was accrued for patients tested from January 2010 to June 2010 including subsequent histologic and cytologic follow-up.
Results: A total of 22160 Pap tests (Thin Prep) were performed in the year 2010 in women ≥ 30 years of age. Of these, 20320 women had negative cytology - 20260 of which were cotested with HPV (Hybrid Capture 2). A negative cytology result with a positive HPV cotest was obtained in 794 patients (3.6% of all patients with Pap tests in this age group). Data analysis was performed for patients tested from January 2010 to June 2010. Of these, patients with a documented history of ≥ ASCUS cytology in the previous 2 years were excluded. 334 patients fit the study criteria – average age 44.6 years (range 30-80 years), 231 (69.2%) had cytologic and/or histologic follow-up (follow-up interval of 0.5 to 29 months). 11 patients underwent immediate colposcopy (within 2 months). HPV genotype-specific testing was not performed in any of the patients. CIN2 or above was identified in 8 (3.5%) patients with follow-up - two CIN3 cases and six CIN2 cases, after an interval of 1 to 24 months (average interval 17.9 months) from the index Pap test. None of the patients were diagnosed with invasive carcinoma on follow-up.
Conclusions: Our study reveals that though a substantial number of women ≥ 30 years of age have HPV positive cytology negative cotests, their short term risk of developing CIN3 or above is very low. Henceforth, instead of immediate colposcopy, follow-up with repeat co-testing after 12 months is reasonable in this group of patients.
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 57, Monday Morning