HPV Testing in Patient Management: Atypical Squamous Cells of Undetermined Significance and Low- Grade Squamous Intraepithelial Lesion

Abstract Context.—Oncogenic, high-risk human papillomavirus (HR-HPV) testing is used to evaluate women who are older than 20 years with atypical squamous cells of undetermined significance (ASC-US) and in conjunction with a screening Papanicolaou test in women older than 30 years. Objectives.—To evaluate the 2006 laboratory practice data from laboratories incorporating human papillomavirus (HPV) testing with the Papanicolaou test. Design.—To use the College of American Pathologists (CAP) Supplemental Questionnaire Survey for 2006 to determine laboratory practices of participants in the CAP Interlaboratory Comparison Program in Cervicovaginal Cytology. Results.—A total of 679 laboratories responded to the questionnaire. Most (73%) refer HPV testing to reference laboratories. Nine percent perform HPV testing in cytology. Forty-five percent offer low-risk HPV (LR-HPV) testing. The most common reflex is ASC-US, although HR-HPV is also offered with low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), or any other Papanicolaou test result. Digene Hybrid Capture II is the most common method. Human papilloma virus median test volumes are 55 monthly. Frequency distributions of HPV test volumes are significantly different from those found in 2003. Laboratories performing in-house testing reported significantly higher monthly HPV volumes (P < .001). Median rates for HR-HPV positivity are 36.6% for ASC-US, 50.0% for atypical squamous cells, cannot exclude HSIL (ASC-H), and 4% for women 30 years of age and older in conjunction with a screening Papanicolaou test. Conclusions.—Reference HPV testing remains the most common pattern. The most common reflex indication is for ASC-US, but HPV testing is modified locally to include a variety of scenarios. LR-HPV testing is commonly offered despite its lack of clinical significance. These data form a baseline for ongoing monitoring of HPV testing practice trends.

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Histology correlation with atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) cytology diagnoses: An argument to ensure ASCUS follow-up that is as aggressive as that for LSIL

Diagnostic Cytopathology ◽

10.1002/(sici)1097-0339(199910)21:4<292::aid-dc13>3.0.co;2-n ◽

1999 ◽

Vol 21 (4) ◽

pp. 292-295 ◽

Cited By ~ 23

Author(s):

Karol A. Dvorak ◽

Mary Finnemore ◽

John A. Maksem

Keyword(s):

Low Grade ◽

Squamous Intraepithelial Lesion ◽

Squamous Cells ◽

Intraepithelial Lesion ◽

Undetermined Significance

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A 2‐Year Prospective Study of Human Papillomavirus Persistence among Women with a Cytological Diagnosis of Atypical Squamous Cells of Undetermined Significance or Low‐Grade Squamous Intraepithelial Lesion

The Journal of Infectious Diseases ◽

10.1086/516784 ◽

2007 ◽

Vol 195 (11) ◽

pp. 1582-1589 ◽

Cited By ~ 234

Author(s):

Martyn Plummer ◽

Mark Schiffman ◽

Philip E. Castle ◽

Delphine Maucort‐Boulch ◽

Cosette M. Wheeler ◽

...

Keyword(s):

Human Papillomavirus ◽

Prospective Study ◽

Low Grade ◽

Cytological Diagnosis ◽

Squamous Intraepithelial Lesion ◽

Squamous Cells ◽

Intraepithelial Lesion ◽

Undetermined Significance

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Evaluation of the In Situ Hybridization Signal Patterns of Liquid-Based Cytological Human Papillomavirus Specimens for Diagnosing Squamous Intraepithelial Lesion

ISRN Pathology ◽

10.5402/2011/219790 ◽

2011 ◽

Vol 2011 ◽

pp. 1-9

Author(s):

Katsunari Ishida ◽

Makoto Nagasaki ◽

Masayuki Kobayashi ◽

Tatsushi Nakagawa ◽

Toru Nabika ◽

...

Keyword(s):

Human Papillomavirus ◽

Low Grade ◽

Squamous Intraepithelial Lesion ◽

Routine Testing ◽

Squamous Cells ◽

Intraepithelial Lesion ◽

Liquid Based Cytology ◽

Undetermined Significance

To examine the diagnostic utility for squamous intraepithelial lesion (SIL) by cytological in situ hybridization (c-ISH) for the human papillomavirus using liquid-based cytology specimens, we investigated c-ISH signal patterns in the cases of low-grade SIL (LSIL), atypical squamous cells of undetermined significance (ASC-US), and high-grade SIL (HSIL). Episomal (E) and/or integrated (I) signals were observed. Two signal patterns (E≧I or I>E) were obtained by counting the number of E+ or I+ cells. E≧I was specific to LSIL and ASC-US (10/12); I>E, to HSIL (9/11) (P<0.01, χ2 test), suggesting significant utility of c-ISH in diagnosing SIL. In the cell fraction, E≧I in large cells was dominant in LSIL. Two cases of I>E in large cells of LSIL showed HPV persistence and/or progression during follow-up. Thus, c-ISH is useful in routine testing for diagnosing cervical dysplastic lesions, especially for detecting LSIL suspected for progression.

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