title: Women >or=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?
abstract: High-risk human papillomavirus (HR-HPV) testing for colposcopy triage of low grade squamous intraepithelial lesion (LSIL) is not recommended because of high positive rates in young women. It remains unclear whether HR-HPV testing may be useful for triage of older women. We compiled HR-HPV data for women aged >or=30 years with LSIL for the period March 1, 2006 to February 28, 2008. Follow-up cervical biopsy information was collected for the period March 1, 2006 to August 15, 2008. We used the Hybrid Capture II test performed on residual material from liquid-based Pap tests. Of 735 women, 254 had HR-HPV testing, and of these 144 had positive HR-HPV results. Among women with positive HR-HPV results 79 underwent biopsy (54.9%) and 11 had cervical intraepithelial neoplasia (CIN) 2 or 3 (13.9% of women with biopsy follow-up). A total of 481 women did not undergo HR-HPV testing, of whom 192 underwent biopsy (39.9%) and 11 had CIN 2 or 3 (5.7% of biopsied women [P = 0.04]). Among women who tested negative for HR-HPV and had follow-up biopsies, only one had a high grade lesion found (CIN 2). The overall HR-HPV positive rate in tested women >or=30 years old with LSIL was 56.7% if women who had reflex HR-HPV testing for ASC-US are included. The HR-HPV positive rate in residual material from Pap tests interpreted as LSIL was 63.8%. Among women >or=30 years of age with LSIL, CIN 2-3 is significantly more likely in HR-HPV positive women. Relatively few older women with LSIL test positive for HR-HPV. Colposcopy triage using HR-HPV may be justified in this population.
authors.affiliation: Department of Pathology, The Methodist Hospital, Houston, Texas 77030, USA. mjthrall@tmhs.org
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Thrall
authors.forename: Debora A
authors.initials: DA
authors.lastname: Smith
authors.forename: Dina R
authors.initials: DR
authors.lastname: Mody
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D003127:Colposcopy; D005260:Female; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000473:pathology; D011230:Precancerous Conditions / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000821:virology / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000821:virology*; D014626:Vaginal Smears