Abstract:
Background: High-risk human papilloma virus (HR-HPV) is a recognized cause of cervical carcinoma and its precursors. HPV
testing is recommended to triage the follow up for women with atypical squamous cells of undetermined significance (ASCUS) on Pap smears. Women with low-grade squamous intraepithelial lesion (LSIL) and above on Pap smears (go on to colposcopy). However, many clinicians request concurrent testing for HR-HPV on cases interpreted as LSIL. This study examines the utility of reflex HPV testing in women with LSIL. Design: Pap smears with LSIL interpretation and concurrent HR-HPV testing between January and December 2005 were retrieved from our CoPath system. The Pap smear interpretation of LSIL was correlated with the corresponding HPV status and available follow up cervical biopsy result.
Results: 193 out of 404 LSIL cases in 2005 had concurrent HPV testing. HR-HPV was detected in 124 of 193 cases (64.2%). Follow up cervical biopsy data was available in 56 of the 193 LSIL cases, among them, 35 were HPV+ and 21 were HPV-. 29 out of 35 LSIL/HPV+ cases (83%) and 19 out of 21 LSIL/HPV- cases (90%) had biopsy diagnosis of CIN I or worse. Conclusion: A high percentage of women with LSIL on Pap smears were positive for HR-HPV, making HPV test an
inadequate triage method. In addition, the HPV status in LSIL cases did not affect the outcome of the subsequent cervical biopsy result. These findings demonstrate that HPV testing is not helpful in triaging women with LSIL on Pap smears.
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