title: Reflex high risk HPV testing in atypical squamous cells, cannot exclude high grade intraepithelial lesion: a large institution's experience with the significance of this often ordered test.
abstract: OBJECTIVE
  Cervical cytology specimens diagnosed with ASC-H consist of squamous cells with equivocal cytology for high-grade dysplastic lesions. We reviewed our cases of ASC-H with reflex HPV testing to evaluate this patient population.
  
  
  METHODS
  We retrospectively identified patients with ASC-H in Pap smears over a 3-year period. Reflex high-risk (HR) HPV DNA testing was performed by request. Follow-up results and smear characteristics were evaluated.
  
  
  RESULTS
  HR HPV DNA testing was positive in 60 of 82 (73%) cases tested. The risk of high grade cervical intraepithelial neoplasia (CIN) on follow-up after a positive HPV test with ASC-H is 68.3%. The risk of high grade CIN after a negative HPV test with ASC-H is 58.3%. High grade CIN lesions were found in 20% HPV-negative patients. The cellularity of atypical cells in Pap smears was not helpful in analyzing differences in HPV-positive and HPV-negative ASC-H.
  
  
  CONCLUSIONS
  The risk of high grade dysplasia after an ASC-H Pap diagnosis was high irrespective of the reflex HPV test results in our patient population. Therefore, our findings support the continued utilization of the current ASCCP guidelines of colposcopy and caution when utilizing reflex HR HPV testing in the colposcopy triage ASC-H patients.
authors.affiliation: Department of Pathology, Division of Cytopathology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1732, USA. ggalliano@mednet.ucla.edu
authors.forename: Gretchen E
authors.initials: GE
authors.lastname: Galliano
authors.forename: Neda A
authors.initials: NA
authors.lastname: Moatamed
authors.forename: Susanna
authors.initials: S
authors.lastname: Lee
authors.forename: Nikki
authors.initials: N
authors.lastname: Salami
authors.forename: Sophia K
authors.initials: SK
authors.lastname: Apple
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002584:Cervix Uteri / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000502:physiology*; D012307:Risk Factors; D014626:Vaginal Smears / Q000379:methods*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000601:surgery / Q000821:virology*