Adjunctive high-risk human papillomavirus DNA testing is a useful option for disease risk assessment in patients with negative Papanicolaou tests without an endocervical/transformation zone sample

Abstract

BACKGROUND. Current guidelines recommend that women with negative Papanicolaou (Pap) test results and no endocervical/transformation zone (EC/TZ) sample return for screening within 12 months. For some women, this represents earlier follow‐up than advocated in several routine screening guidelines. Controversy remains with regard to the correlation between sampling of the EC/TZ, Pap test quality, and disease risk assessment. METHODS. A retrospective study was conducted reviewing the results from 143,438 liquid‐based cervical Pap tests performed at a large academic women's hospital between July 2005 and December 2006. Vaginal Pap tests were excluded from the study. Women with any Pap result, women with low–grade squamous intraepithelial lesions (LSILs), and patients with high–grade squamous intraepithelial lesion (HSIL) Pap test results were stratified by 10‐year age groups and according to the presence or absence of an EC/TZ sample (EC/TZS). Women with LSIL and HSIL Pap test results with and without an EC/TZS were also compared for rates of high–risk human papillomavirus (hrHPV) DNA detection. RESULTS. Of the total of 143,438 cervical Pap tests performed, 27,359 (19.1%) were reported to be lacking an EC/TZS. The absence of an EC/TZS was found to be highest in adolescents and in mature women aged ≥50 years. The overall detection rate of LSIL was 4.29% and that of HSIL was 0.64%. Both the LSIL and HSIL rates were found to be significantly higher in Pap tests with an EC/TZS compared with Pap tests without an EC/TZS (LSIL: 4.51% vs 3.37% and HSIL: 0.72% vs 0.29%). However, when women with LSILs and HSILs were divided into a group in which EC/TZS was present and a group in which EC/TZS was absent, no significant differences were found to be present with regard to hrHPV DNA rates between the 2 groups. CONCLUSIONS. Adjunctive hrHPV DNA testing is effective in stratifying risk for the presence of SIL in women with and without an EC/TZS. This finding is consistent with recently reported data from >9000 patients with negative Pap results, which found that hrHPV DNA–positive test rates are independent of the presence or absence of an EC/TZS. hrHPV DNA results provide a useful new optional adjunctive tool for the objective stratification of disease risk in women with negative Pap tests and no EC/TZS. Cancer (Cancer Cytopathol) 2008. © 2008 American Cancer Society.

Heavy Cervical Cancer Burden in Elderly Women: How Can We Improve the Situation?

“…Little data is available on this new approach in screening older women, although the high prevalence of HPV infection may make this group a good target for testing. HPV testing not only increases the sensitivity of Pap smear, but its effect is independent of cytologic sampling of the transformation zone and endocervical canal, and is thus capable of alleviating the sampling difficulty mentioned earlier [29,30]. …”

Histopathologic follow‐up and human papillomavirus DNA test results in 290 patients with high–grade squamous intraepithelial lesion papanicolaou test results

“…The reporting profile of the laboratory is documented in numerous recent publications. [23][24][25][26][27][28][29][30][31] Original Article…”

Risk of CIN2 in Women With a Pap Test Without Endocervical Cells vs. Those With a Negative Pap Test With Endocervical Cells

“…3 Although the frequency of smears lacking ECC is commonly accepted as an indicator of sampling 2 quality, recommendations following a smear without ECC in a screening setting are still under debate. [4][5][6][7][8][9][10] The Bethesda System (TBS) 2001 recommends repeat screening after 1 year, 11 which is the screening interval most used in the United States, 6 but it is definitely shorter than the usual interval for most European programs, have adopted a 3-5-year interval. 12 Adopting a shorter interval should be based on evidence of a higher risk of cervical neoplasia in these cases as compared to negative smears with ECC.…”