Oncogenic human papillomavirus testing in an adolescent population with atypical squamous cells of undetermined significance

Abstract

Objective: The American Society for Colposcopy and Cervical Pathology 2006 consensus guidelines state that oncogenic human papillomavirus (HPV) DNA testing is unacceptable for patients 20 years and younger with atypical squamous cells of undetermined significance (ASC-US). The objective of this study is to determine the HPV frequency in ASC-US patients 20 years and younger and to investigate subsequent colposcopic diagnoses.

Materials and methods: Cytopathology records at the University of Florida/Shands-UF were reviewed from March 2003 to June 2007 to identify patients 20 years and younger with ASC-US on screening Pap tests. Human papillomavirus test results and subsequent colposcopic diagnoses were recorded.

Results: A total of 333 patients were identified. Seventy-five were not HPV tested. Of the remaining 258, 127 (49%) were negative(-) for HPV, whereas 131 (51%) were HPV positive(+).In the HPV(-) population (n=127), 3 (2%) patients were referred for colposcopy and had benign findings. In the HPV(+) population (n=131), 48 (37%) patients were referred for colposcopy. Of these 48, 25 had benign colposcopic findings, 12 had cervical intraepithelial neoplasia 1 (CIN 1), and 11 had CIN 2/3. No invasive disease was identified. Nine of the 11 patients with CIN 2/3 were 18 years and older.

Conclusions: In our institution, 51% of ASC-US patients 20 years and younger were HPV(+). Colposcopy with subsequent histological diagnosis, available on 48 patients, demonstrated 11 (23%) of the HPV(+) group to have CIN 2/3. The American Society for Colposcopy and Cervical Pathology guidelines recommend observation (via repeat colposcopy and cytology) for adolescents with CIN 2 and treatment (via excision or ablation) for CIN 3. Human papillomavirus testing ASC-US adolescents in our institution may be "acceptable."