title: Relevance of the Pap Test: A Report of HPV-DNA Test-Negative High-Grade Squamous Intraepithelial Lesions of the Female Lower Genital Tract.
abstract: OBJECTIVE
  A vast majority of cervicovaginal intraepithelial lesions are caused by high-risk human papillomaviruses (HPVs). The Pap test has been the sole method used for the screening of cervicovaginal squamous intraepithelial lesions (SIL). Recently, the FDA approved an HPV-DNA assay as a method of primary screening. We report on a series of FDA-approved HPV-DNA test-negative SIL with HPV genotyping, using an alternative method on the corresponding surgical biopsy specimens.
  
  
  METHODS
  A retrospective review identified cytology-positive HPV-negative cases over a 15-month period at a tertiary care gynecologic oncology institution. Corresponding biopsies were reviewed and genotyped for high-risk HPVs.
  
  
  RESULTS
  Of the 18,200 total cases, 17 patients meeting the study criteria were selected with 27 surgical specimens corresponding to their cytologic diagnoses. Four patients with high-grade lesions were identified, 3 of whom (75%) were positive for HPV. One of these 4 patients (25%) showed high-grade SIL on biopsies from 4 separate sites in the cervix and vagina. Multiviral HPV infections were frequent.
  
  
  CONCLUSIONS
  We discuss the relevance of cotesting for screening cervical SILs and emphasize that false-negative results are possible with the FDA-approved HPV screening assay, also in patients with high-grade SIL. These cases may be detectable by cytologic examination and this suggests that the Pap test remains an important diagnostic tool.
authors: Department of Pathology, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, R.I., USA.
authors: Yiang
authors: Y
authors: Hui
authors: Katrine
authors: K
authors: Hansen
authors: Jayasimha
authors: J
authors: Murthy
authors: Danielle
authors: D
authors: Chau
authors: C James
authors: CJ
authors: Sung
authors: M Ruhul
authors: MR
authors: Quddus
mesh_terms: D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000473:pathology / Q000821:virology; D003127:Colposcopy / Q000379:methods; D004279:DNA, Viral / Q000235:genetics*; D005260:Female; D005838:Genotype; D061809:Human Papillomavirus DNA Tests / Q000379:methods; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test / Q000379:methods; D027383:Papillomaviridae / Q000235:genetics*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000473:pathology*; D012189:Retrospective Studies; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000175:diagnosis* / Q000473:pathology* / Q000821:virology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000821:virology; D014626:Vaginal Smears / Q000379:methods; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000473:pathology / Q000821:virology
chemical_list: D004279:DNA, Viral