Women ≥30 years of age with low grade squamous intraepithelial lesion (LSIL) have low positivity rates when cotested for high‐risk human papillomavirus: Should we reconsider HPV triage for LSIL in older women?

Thrall, Michael J.; Smith, A C T Debora; Mody, Dina R.

doi:10.1002/dc.21209

Cited by 21 publications

(18 citation statements)

References 16 publications

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“…Based on previous studies, high-risk HPV was detected in 83% of women with LSIL cytology and a mean age of 24.9 years. Our result is in agreement with other studies which implies that it might be useful to triage women in the 21-40 year age group with LSIL (Ronco et al, 2007;Thrall et al, 2009).…”

Section: Discussionsupporting

confidence: 93%

Clinical Prediction Based on HPV DNA Testing by Hybrid Capture 2 (HC2) in Combination with Liquid-based Cytology (LBC)

Junyangdikul

Tanchotsrinon²,

Chansaenroj³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Primary screening by HPV DNA testing is an effective method for reducing cervical cancer and has proven more sensitive than cytology. To advance this approach, many molecular methods have been developed. Hybrid capture 2 provides semi-quantitative results in ratios of relative light units and positive cutoff values (RLU/ PC). Twenty-five thousand and five patients were included in this study to analyze the correlation between the ratio of RLU/PC and stage of cervical dysplasia. The results show that the RLU/PC ratios ranged from 0-3500 while almost normal cases, ASC-US and ASC-H, had values below 200. Of those samples negative for cytology markers, 94.6% were normal and their RLU/PC ratios were less than 4. With an RLU/PC ratio greater than 4 and less than or equal to 300, the percentages in all age groups were normal 53.6%, LSIL 20.2%, ASC-US 17.2%, HSIL 6.13%, ASC-H 2.72%, and AGC 0.11%, respectively. In contrast, 64.0% of samples with a RLU/ PC ratio greater than 300 and less than or equal to 3500 were LSIL. These results should contribute to cost effective cervical cancer management strategies. Further studies of associations with particular HPV genotypes would be useful to predict the risk of progression to cancer.

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Section: Discussionsupporting

confidence: 93%

Clinical Prediction Based on HPV DNA Testing by Hybrid Capture 2 (HC2) in Combination with Liquid-based Cytology (LBC)

Junyangdikul

Tanchotsrinon²,

Chansaenroj³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…Our data and other published studies have shown that the prevalence of both hrHPV DNA positivity and CIN 2/3 decline with age in women with LSIL Paps [5,7,26,30]. Another study demonstrated that older women are more likely to have persistent HPV infection than younger women, even though most infections by the hrHPV types still clear in 2 years [31].…”

Section: Discussionmentioning

confidence: 52%

“…Since only a minority of patients with LSIL are found to harbor or later develop a high-grade CIN [21,22 ]or even more rarely a cervical carcinoma [22,23], management of LSIL remains a major challenge to system efficiency [25]. With ongoing accumulation of age-stratified data sets, the utility of HPV testing in older patients with LSIL Paps continues to spark interest [5,6,7,26]. To the best of our knowledge, our study is the largest to date to examine histopathological follow-up of patients from diverse older age groups with LSIL cytological interpretations and concurrent hrHPV DNA testing.…”

Section: Discussionmentioning

confidence: 99%

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

2010

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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.

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“…Other studies have also suggested that HR HPV testing of older women with LSIL may be rational because of the relatively high percentage of women who were negative for HR HPV. 3,7,13 Given the ACOG guidelines for HR HPV cotesting in women aged 30 years, in many cases HR HPV status may already be known. In this scenario, a known prior positive HR HPV cotesting result would avoid the need for and the additional cost of reflex HR HPV testing of a woman with LSIL cytology.…”

Section: Discussionmentioning

confidence: 99%

“…Subsequent studies have suggested that HR HPV DNA testing may be useful in triaging older women with LSIL. [2][3][4] With the introduction of HR HPV cotesting, more and more women with LSIL have been tested for HR HPV. The objective of the current study was to correlate the status of HR HPV and the subsequent detection of high-grade dysplasia in women with LSIL.…”

mentioning

confidence: 99%

Use of high‐risk human papillomavirus testing in patients with low‐grade squamous intraepithelial lesions

Levi

Harigopal

Hui

et al. 2011

Cancer Cytopathology

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BACKGROUNDThe role of testing for high‐risk human papillomavirus (HR HPV) when triaging women with a cytologic diagnosis of low‐grade squamous intraepithelial lesion (LSIL) has not been well established. The objective of the current study was to correlate the status of HR HPV with the incidence of cervical intraepithelial neoplasia 2 and more severe lesions (CIN 2+) on tissue follow‐up in women with LSIL.METHODSA total of 1046 women with LSIL and HR HPV testing were identified in the database of a large teaching hospital within a 12‐month period. HR HPV testing was performed using the Hybrid Capture 2 assay with 1 relative light unit/cutoff as the cutoff.RESULTSOf the 1046 women with LSIL and concurrent HR HPV testing, 82.3% tested positive for HR HPV, 91.1% of whom were women aged < 30 years and 73% of whom were women aged ≥ 30 years (P < .001). Cytologic and/or histologic follow‐up was available in 979 (93.6%) women; 25.5% had negative follow‐up, 62.5% were found to have CIN 1 lesions, and 12.0% had CIN 2+ lesions. The sensitivity and negative predictive value of HR HPV status as a marker of CIN 2+ lesions were 98.3% and 98.9%, respectively. The colposcopy rate was 73.3% and 96.9% for women aged ≥ 30 years and women aged < 30 years, respectively (P = .01).CONCLUSIONSUsing 1 RLU/CO as the cutoff value, HR HPV testing was found to be highly sensitive for detecting CIN 2+ lesions in women with LSIL. The colposcopy rate was significantly lower in women aged ≥ 30 years compared with women aged < 30 years. Triaging with HR HPV testing may be indicated in women aged ≥ 30 years with LSIL cytology, but not in women aged < 30 years. Cancer (Cancer Cytopathol) 2011;. © 2011 American Cancer Society.

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Women ≥30 years of age with low grade squamous intraepithelial lesion (LSIL) have low positivity rates when cotested for high‐risk human papillomavirus: Should we reconsider HPV triage for LSIL in older women?

Cited by 21 publications

References 16 publications

Clinical Prediction Based on HPV DNA Testing by Hybrid Capture 2 (HC2) in Combination with Liquid-based Cytology (LBC)

Clinical Prediction Based on HPV DNA Testing by Hybrid Capture 2 (HC2) in Combination with Liquid-based Cytology (LBC)

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

Use of high‐risk human papillomavirus testing in patients with low‐grade squamous intraepithelial lesions

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