title: Impact of Possibly Oncogenic High-Risk Human Papillomavirus (HPV) Types in Triage for ASC-US Cervical Cytology Results.
abstract: OBJECTIVE
  Current guidelines recommend including 13 or 14 high-risk human papillomavirus (HPV) types for triage of atypical squamous cells of undetermined significance (ASC-US) cervical cytology; however, at least 13 additional types are considered possibly oncogenic. We evaluated the effect of including possibly oncogenic HPV types in the test panel.
  
  
  METHODS
  Outcomes for all women 30 years or older with ASC-US and positive HPV testing who underwent colposcopic biopsy at University of Washington Medical Center-affiliated clinics between 2010 and 2011 were reviewed. We compared biopsy results between cases that were HPV positive for 1 or more of 13 possibly oncogenic types only (26/53/55/62/64/67/69/71/73/82/83/84/IS39) versus 1 or more of the 14 established high-risk types (16/18/31/33/35/39/45/51/52/56/58/59/66/68). We used the Fisher exact test to compare cervical intraepithelial neoplasia grade 2 or higher (CIN2+) diagnoses between HPV risk groups.
  
  
  RESULTS
  Three hundred twenty-six ASC-US HPV-positive cervical cytology results were identified, with 170 that were linked to subsequent cervical biopsy results. Among 51 cases positive for possibly oncogenic types only, 31 (61%) had no neoplasia, 20 (39%) had CIN1, and none had CIN2+. Among 119 controls positive for at least one established high-risk type, 64 (53%) had no neoplasia, 42 (35%) had CIN1, and 13 (11%) had CIN2+ (p = .01 for the comparison of CIN2+ diagnoses between groups).
  
  
  CONCLUSIONS
  The inclusion of possibly oncogenic types in the HPV test panel led to an additional 51 colposcopy biopsies (33% increase), with no additional cases of CIN 2+. Our results suggest that including possibly oncogenic HPV types increases the number of colposcopy biopsies with minimal improvements in detection of CIN2 +.
authors.affiliation: 1Department of Obstetrics and Gynecology, University of Washington, Seattle, WA; 2Department of Epidemiology, University of Washington, Seattle, WA; and 3Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Amarosa
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Winer
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Hong
authors.forename: Constance
authors.initials: C
authors.lastname: Mao
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D065309:Atypical Squamous Cells of the Cervix / Q000166:cytology*; D001706:Biopsy; D003127:Colposcopy; D005260:Female; D005838:Genotype; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000145:classification / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000821:virology; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000628:therapy; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000628:therapy; D014861:Washington