Should women with atypical squamous cells, cannot exclude high‐grade squamous intraepithelial lesion, receive reflex human papillomavirus‐DNA testing?

• Published in: Cancer Vol. 105; no. 6; pp. 457 - 460
• Main Authors: Liman, Agnes K., Giampoli, Ellen J., Bonfiglio, Thomas A.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 25.12.2005; Wiley-Liss
• Subjects: atypical squamous cells; Biological and medical sciences; cannot exclude high‐grade intraepithelial lesion; Cervical Intraepithelial Neoplasia - complications; Cervical Intraepithelial Neoplasia - diagnosis; Cervical Intraepithelial Neoplasia - virology; Colposcopy; DNA, Viral - analysis; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; liquid‐based cytology; Medical sciences; Neoplasms, Squamous Cell - complications; Neoplasms, Squamous Cell - diagnosis; Neoplasms, Squamous Cell - virology; Papanicolaou Test; Papillomaviridae - genetics; Pilot Projects; reflex human papillomavirus‐DNA testing; Retrospective Studies; Sensitivity and Specificity; Tumors; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - virology; Vaginal Smears; Human; Reflex; Premalignant lesion; Colposcopy; Cytology; Papovaviridae; Medical screening; Female genital diseases; High grade; Papillomavirus; Virus; cannot exclude high-grade intraepithelial lesion; reflex human papillomavirus-DNA testing; liquid-based cytology; Human papillomavirus; Cancerology; Cervical dysplasia; DNA; Squamous intraepithelial lesion; Adult; Female; Atypical; Intraepithelial neoplasia; Uterine cervix diseases; atypical squamous cells; High malignancy
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.21387

BACKGROUND The 2001 American Society for Colposcopy and Cervical Pathology Consensus Guidelines recommend that women who have Papanicolaou (Pap) smears diagnosed as atypical squamous cells (ASC), cannot exclude high‐grade squamous intraepithelial lesion (HSIL) (ASC‐H) should be referred for immediate colposcopic examination. The objective of this pilot study was to evaluate whether reflex human papillomavirus (HPV)‐DNA testing performed on smears diagnosed as ASC‐H may obviate the need for immediate colposcopic examination. METHODS All ThinPrep Pap smears that were diagnosed as ASC‐H or atypical squamous metaplastic cells (ASMT) between 2001–2003 and that had HPV‐DNA testing and subsequent histologic and/or cytologic follow‐up were evaluated. Those smears that were diagnosed as ASMT were reviewed and reclassified under the 2001 Bethesda System as either ASC of undetermined significance (ASCUS) or ASC‐H. Smears that were diagnosed as ASCUS were excluded from the study. RESULTS The study included of 48 smears that were diagnosed as ASC‐H. All patients with biopsy‐proven HSIL had positive high‐risk (HR)‐HPV results (100% negative predictive value). Approximately 80% of patients with ASC‐H who had biopsy‐proven, low‐grade intraepithelial lesion on follow‐up had positive HR‐HPV results. Among the patients who had ASC‐H with negative follow‐up, 50% had positive HR‐HPV results, and 50% had negative HR‐HPV results. CONCLUSIONS Among patients with ASC‐H, a negative HR‐HPV result was found to be an excellent predictor of the absence of HSIL. The results of this pilot study suggested that HPV‐DNA testing may serve as a means to better select which patients with ASC‐H on Pap smear should undergo colposcopic examination. This approach potentially may reduce medical costs and eliminate the need for routine colposcopic examination among patients with ASC‐H Pap smears. Cancer (Cancer Cytopathol) 2005. © 2005 American Cancer Society. The results from this study showed that a negative high‐risk human papillomavirus (HPV) result was an excellent predictor of the absence of high‐grade squamous intraepithelial lesion (HSIL) in subsequent follow‐up biopsy. The authors propose that HPV‐DNA testing for triage for patients with atypical squamous cells, cannot exclude HSIL is a feasible, cost‐effective alternative to colposcopic examination.