HrHPV positivity in ASC-US Papanicolaou tests from women with treated HPV- and non-HPV-related gynecologic malignancies

Introduction: Although the utility of high-risk human papillomavirus (hrHPV) testing is established in the triage of ASC-US Papanicolaou tests from the general population, its role in women who have been treated for cervical cancer and other HPV-related cancers is less clear. Materials and methods: Records of patients with ASC-US Papanicolaou tests and HPV testing results submitted by our gynecologic oncology service with a history of malignancy between 2006 and 2012 were reviewed. Results: Thirty-nine women with a history of treatment for HPV-related cancer and ASC-US Papanicolaou tests who had undergone hrHPV testing were identified. hrHPV was detected in the in specimens from 12 of the 39 patients. Among the 12 patients with ASC-US/hrHPV+ Papanicolaou tests, 2 had a subsequent Papanicolaou test with high-grade squamous intraepithelial lesion (HSIL) and 1 had a cervical biopsy that showed invasive squamous cell carcinoma. Among the 27 patients with ASC-US/hrHPV- Papanicolaou tests with pathologic follow-up, none had HSIL or worse. In patients with treated non-HPV-related cancers, hrHPV was detected in cervical/vaginal cytology specimens from 11 of 47 patients. Of 11 patients with ASCUS/hrHPV+ Papanicolaou tests, 1 had an HSIL Papanicolaou test and a negative vaginal biopsy within 18 months. None of the 36 patients with ASC-US/hrHPV- Papanicolaou tests had HSIL or worse on follow-up. Conclusion: The rates of hrHPV positivity in ASC-US Papanicolaou tests from women treated for both HPV-related (31%) and non-HPV-related (23%) gynecologic malignancies were similar to those reported in women older than 45 years. hrHPV testing identified all women with ASC-US Papanicolaou tests who subsequently developed HSIL or worse.