Premium
Discrepant HPV/cytology cotesting results: Are there differences between cytology‐negative versus HPV‐negative cervical intraepithelial neoplasia?
Author(s) -
Tracht Jessica M.,
Davis Antoinette D.,
Fasciano Danielle N.,
Eltoum IsamEldin A.
Publication year - 2017
Publication title -
cancer cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.29
H-Index - 57
eISSN - 1934-6638
pISSN - 1934-662X
DOI - 10.1002/cncy.21905
Subject(s) - ascus (bryozoa) , medicine , cytology , cervical intraepithelial neoplasia , gynecology , squamous intraepithelial lesion , malignancy , cytopathology , papillomaviridae , cervical cancer , biopsy , cancer , pathology , biology , botany , ascospore , spore
BACKGROUND The objective of this study was to compare cervical high‐grade squamous intraepithelial lesions subcategorized as cervical intraepithelial neoplasia‐3 (CIN‐3)–positive after a negative cytology result but positive for high‐risk human papillomavirus (HR‐HPV) testing to those with a negative HR‐HPV test but positive cytology (atypical squamous cells of undetermined significance [ASCUS]‐positive/HPV‐negative) and to assess reasons for discrepancies. METHODS The authors retrospectively analyzed women who underwent screening with cytology and HPV testing from 2010 through 2013. After a review of surgical specimens and cytology, discrepancies were classified as sampling or interpretation error. Clinical and pathologic findings were compared. RESULTS In total, 15,173 women (age range, 25‐95 years; 7.1% were aged < 30 years) underwent both HPV and cytologic testing, and 1184 (8.4%) underwent biopsy. Cytology was positive in 19.4% of specimens, and HPV was positive in 14.5%. Eighty‐four CIN‐3–positive specimens were detected, including 55 that tested ASCUS‐positive/HPV‐positive, 11 that tested negative for intraepithelial lesion or malignancy (NILM)/HPV‐positive, 10 that tested ASCUS‐positive/HPV‐negative, 3 that tested NILM/HPV‐negative, and 5 tests that were unsatisfactory. There was no significant difference between NILM/HPV‐positive and ASCUS‐positive/HPV‐negative CIN‐3 in terms of size, time to occurrence, the presence of a cytopathic effect, screening history, race, or age. Six of 11 NILM/HPV‐positive cases were reclassified as ASCUS, indicating an interpreting error of 55% and a sampling error of 45%. No ASCUS‐positive/HPV‐negative cases were reclassified. Seven cases of CIN‐3 with positive cytology were HPV‐negative. CONCLUSIONS There are no significant clinical or pathologic differences between NILM/HPV‐positive and ASCUS‐positive/HPV‐negative CIN‐3–positive specimens. Cytologic sampling or interpretation remains the main reason for discrepancies. However, HPV‐negative CIN‐3 with positive cytology exists and may be missed by primary HPV screening. Cancer Cytopathol 2017;125:795‐805 . © 2017 American Cancer Society .