Anatomic Pathology / REFLEX HPV TESTING IN CLINICAL PRACTICE Reflex High-Risk Human Papillomavirus Testing for Women With Atypical Squamous Cells of Undetermined Significance in Cytologic Smears Effects Since Implementation in a Large Clinical Practice

Reflex high-risk human papillomavirus (HPV) testing often is used in the management of women with atypical squamous cells of undetermined significance identified in cervicovaginal screening. Following implementation of reflex testing, our laboratory processed 8,022 specimens during a 20-month period; sufficient material was available for testing in 7,334 specimens. High-risk HPV was detected in 34.10% of these specimens. Detection rates varied with age, with positive rates as high as 58.46% in women 20 years old or younger, decreasing to 14.58% in women older than 35 years. The detection rate, categorized in 5-year age increments, showed a significant decrease until after 35 years, when the rate remained fairly constant (P < .0001). The detection rate decreased over the time of the study. These results demonstrate that high-risk HPV detection might vary according to the age mix of the population tested and the interval after implementation of testing. The management of women with atypical squamous cells of undetermined significance (ASCUS) identified in cytologic screening has gone through significant evolution during recent years, primarily owing to the availability of testing for the presence of high-risk human papillomavirus (HPV). Several studies have demonstrated this testing to be highly sensitive for the detection of cervical intraepithelial neoplasia grades 2 and 3 in women with an ASCUS diagnosis from a cytology smear, and the large Atypical Squamous Cell of Undetermined Significance/ Low-Grade Squamous Intraepithelial Lesion Study (ALTS) showed that in women with ASCUS identified in smears, high-risk HPV testing had greater sensitivity than and specificity comparable to repeated cytologic smears in the detection of cervical intraepithelial neoplasia 3 or higher.1-5 Based on these studies, the 2001 consensus guidelines published by the American Society for Colposcopy and Cervical Pathology listed high-risk HPV testing as the “preferred” option for the triage of woman with ASCUS identified in smears.6 Although these reports described the usefulness of viral testing in the triage of women with ASCUS identified in smears, little has been reported about the use of high-risk HPV testing on a large scale in clinical practice, particularly in relation to considerations such as patient age and trends in testing results over time, with implementation of widespread reflex testing. Our purpose was to evaluate our experience with reflex high-risk HPV testing in women with ASCUS identified in smears in a large clinical practice, to ascertain whether rates of test positivity were affected by patient age and whether there were changes in positivity rates over time after the implementation of reflex testing.