Review of Cytology Practice at Thomas Jefferson University Hospital before and after High-Risk Human Papillomavirus Testing

Abstract

Objective: We performed a retrospective review of Papanicolaou (Pap) testing to assess whether the cytology practice in our institution was affected by the introduction of high-risk (HR) human papillomavirus (HPV) assays over time. Study Design: Cytology, HPV and histopathology records were retrieved from our laboratory information system from 2003 to 2015. Records for Digene Hybrid Capture 2®, Hologic Cervista® and Roche Cobas® HPV assays were obtained. A 3-month follow-up for HPV detected cases was performed, and results were correlated with cytology and biopsies. A 1-year follow-up of HPV 16/18 and other HR HPV detected cases was also performed. Results: From 2008 to 2015, a noticeable decrease in Pap testing volume occurred, from 11,792 to 4,664, while the percentage of HPV testing increased from 19 to 59%. Similar HPV detection rates and follow-up results for both reflex and cotesting were observed in the 3 HPV assays. Conclusions: The decrease in Pap testing was due to the lengthening of the test interval when cotesting results were negative. Practitioners adhering to guidelines accounts for increased molecular testing volume. A trend towards higher-grade cervical intraepithelial neoplasia in the follow-up of detected HPV 16/18 was noted. So far there has been no demand for HPV as a stand-alone test.

The Role of Gynecological Cytology in the Era of Molecular Testing

“…Musselwhite et al [3] provide a comprehensive overview on the ethnic differences in cervical cancer control on the global scale. The contributions of Valentine et al [4], and Bibbo et al [5] offer interesting historical perspectives on diagnostic cytology before and after the introduction of HPV testing to the daily routine in two major laboratories of cytology in Europe and the USA, respectively. The innovative research data and clinical applications of p16 biomarker testing in gynecological cytopathology are discussed by Bergeron and von Knebel Doeberitz [6], two recognized experts in the field.…”