Women ≥30 Years of Age With Low Grade Squamous Intraepithelial Lesion (LSIL) Have Low Positivity Rates When Cotested for High-Risk Human Papillomavirus: Should We Reconsider HPV Triage for LSIL in Older Women?

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High-risk human papillomavirus (HR-HPV) testing for colposcopy triage of low grade squamous intraepithelial lesion (LSIL) is not recommended because of high positive rates in young women. It remains unclear whether HR-HPV testing may be useful for triage of older women. We compiled HR-HPV data for women aged ≥30 years with LSIL for the period March 1, 2006 to February 28, 2008. Follow-up cervical biopsy information was collected for the period March 1, 2006 to August 15, 2008. We used the Hybrid Capture II test performed on residual material from liquid-based Pap tests. Of 735 women, 254 had HRHPV testing, and of these 144 had positive HR-HPV results. Among women with positive HR-HPV results 79 underwent biopsy (54.9%) and 11 had cervical intraepithelial neoplasia (CIN) 2 or 3 (13.9% of women with biopsy follow-up). A total of 481 women did not undergo HR-HPV testing, of whom 192 underwent biopsy (39.9%) and 11 had CIN 2 or 3 (5.7% of biopsied women [P=0.04]). Among women who tested negative for HR-HPV and had follow-up biopsies, only one had a high grade lesion found (CIN 2). The overall HR-HPV positive rate in tested women ≥30 years old with LSIL was 56.7% if women who had reflex HR-HPV testing for ASC-US are included. The HR-HPV positive rate in residual material from Pap tests interpreted as LSIL was 63.8%. Among women ≥30 years of age with LSIL, CIN 2-3 is significantly more likely in HR-HPV positive women. Relatively few older women with LSIL test positive for HR-HPV. Colposcopy triage using HR-HPV may be justified in this population. Diagn. Cytopathol. 2010;38:407-412.

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