Value of combining HPV-DNA testing with follow-up Papanicolaou smear in patients with prior atypical squamous cells of undetermined significance.

OBJECTIVE

To address human papillomavirus (HPV) testing on negative Pap tests preceded by atypical squamous cells of undetermined significance (ASC-US) without reflex HPV testing.

STUDY

DESIGN

Positive HPV test results with concurrent negative Pap tests over 1 year were identified. Pathology records for all patients diagnosed with ASCUS without reflex HPV testing in the previous year were reviewed; all cytologic and surgical specimens over the subsequent 2 years were evaluated for squamous abnormalities.

RESULTS

Fifty patients had positive HPV DNA (HPV-DNA) test result combined with a negative Pap test. Twenty-three had a previous Pap test interpretation of ASC-US (without HPV testing) within the preceding year. On follow-up, 8 of 23 developed a squamous intraepithelial lesion (SIL) within 1 year. Four additional cases developed SIL in the second year after positive HPV testing. All dysplasias in the first year of follow-up were low grade; 1 of 4 developing in the second year was high grade.

CONCLUSION

Negative Pap smear following an ASC-US interpretation without a concurrent HPV test is associated with significant false negative rate. We suggest consideration of combining HPV-DNA testing to all initial follow-up negative Pap tests of patients with previous ASC-US, if reflex HPV testing has not been performed.