HPV Test Results Stratify Risk for Histopathologic Follow-Up Findings of High-Grade Cervical Intra-Epithelial Neoplasia in Women with Low-Grade Squamous Intra-Epithelial Lesion Pap Results

Abstract

Objective: Age-adjusted evaluations have explored the possible utility of human papillomavirus (HPV) test results in women with low-grade squamous intra-epithelial lesion (LSIL) Paps. We document LSIL correlation data with HPV test results and histopathologic follow-up from a large academic women’s hospital practice. Study Design: LSIL Pap tests with intermediate-/high-risk HPV DNA testing between July 1, 2005 and April 30, 2008 were studied along with follow-up histopathologic diagnoses. Patients were divided into age groups, and tissue diagnoses were correlated with HPV test results. Results: 1,083 (80.2%) of a total of 1,351 LSIL Pap samples tested HPV positive. HPV prevalence declined in older age groups. 719 women with LSIL Pap and HPV test results had at least 1 follow-up cervical biopsy result. 89 of 612 patients with HPV-positive LSIL (14.5%) had a follow-up histopathological diagnosis of cervical intra-epithelial neoplasia (CIN) 2/3. Only 4 of 107 patients with HPV-negative LSIL (3.7%) had CIN 2/3. Conclusions: In the largest study to date to document histopathological follow-up of older women with LSIL and HPV test results, no histopathological CIN 2/3 diagnoses were identified in women 50 years and older with HPV-negative LSIL. HPV test results stratified women with LSIL cytology findings into lower- and higher-risk groups for follow-up histopathologic CIN 2/3 outcomes.

Human papillomavirus DNA detection in women with normal and abnormal cervical Pap cytology

“…There was a clear decline in the HPV prevalence in older age groups. 11 These HPV prevalence data are slightly higher than the meta-analysis performed by Arbyn 12 (76.6%) but are still within the range of previously reported studies (58e85%). Ronco et al also reported that the hrHPV-positive rate was significantly higher in younger women, and that there was a statistically significant decrease in older age groups.…”

“…5 MWH's data indicated that 89 of 612 patients with HPV-positive LSIL (14.5%) had a follow-up histopathological diagnosis of CIN 2/3; only 4 of 107 (3.7%) patients with HPV-negative LSIL had CIN 2/3; no histopathological CIN 2/3 diagnoses were identified in women 50 years and older with HPV-negative LSIL. 11 HPV test results stratified women with LSIL cytology findings into lower and higher-risk groups for follow-up histopathologic CIN 2/3 outcomes. hrHPV testing is highly sensitive for detection of high grade cervical squamous lesions, with high NPV but limited specificity.…”

“…Therefore, an age cutoff of 50 years may prove more practical application in clinical practices. 11 For triage of women with LSIL cytology, Sorbye et al documented that HPV mRNA testing was more sensitive and specific than repeat cytology testing. 14 In addition, the HPV mRNA test showed higher PPV.…”

“…Additionally, HPV types have been referred to as low-risk or high-risk, based on their associated risk for cervical cancer. Low-risk HPV (lrHPV) types (6,11,42,43,44,54,61,70,72, and 81) are virtually never found in cancers and are also called non-carcinogenic HPV. High-risk HPV (hrHPV) types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82) have been identified in cancers of the cervix, vagina, vulva, anus, and penis and are also called carcinogenic or oncogenic HPV.…”

Correlation of Histopathologic Follow-up Findings With Vaginal Human Papillomavirus and Low-Grade Squamous Intraepithelial Lesion Papanicolaou Test Results

“…One possible explanation for this finding could be that the VAIN 1 lesions harbor low-risk HPV types that are not detected by the high-risk HC2 test. In one study, 33 performed on vaginal biopsies, 35% of patients with VAIN 1 tested positive for low-risk HPV types. Another possible explanation could be an overinterpretation of nonneoplastic, mild vaginal squamous atypia as VAIN 1.…”