HPV Cotesting of Unsatisfactory ThinPrep Pap Tests: A Study on Assurance of Negative HPV Results and Compliance with American Society of Colposcopy and Cervical Pathology (ASCCP) Management Guidelines

Document Type

Conference Proceeding

Publication Date

3-1-2025

Publication Title

Lab Invest

Abstract

Background: The 2019 guidelines from ASCCP continue to recommend that individuals with an unsatisfactory Pap test (UPT) and negative HPV cotesting undergo repeat age-based screening within 2 to 4 months. This recommendation is based on the rationale that a negative HPV result in the context of a UPT may indicate an inadequate sample rather than a true negative result. Despite this, only a few studies have examined adherence to these recommended guidelines. Some research suggests that women with UPT and negative HPV may be safely called back for screening at intervals longer than 4 months. This study aims to assess the reliability of negative HPV results in cases of UPT and evaluate our institution's adherence to the ASCCP guidelines. Design: We conducted a retrospective study, selecting all unsatisfactory ThinPrep Pap cases from January 2021 to December 2023. We gathered data on the causes of UPTs, HPV results, and follow-up information for the available cases. The criteria for determining sample adequacy were based on the 2014 Bethesda System. Results: Out of a total of 169,896 Pap tests, 480 UPTs were identified, with an age range of 20 to 83 years. The overall unsatisfactory rate was 0.3%. Among these, 423 cases (88.1%) were attributed to paucicellularity: 170 of these (40.2%) were related to bloody specimens, 72 (17.0%) resulted from inappropriate lubricant usage, and 181 (42.8%) did not show recognizable causes. Additionally, 57 cases (11.9%) were caused by excessive inflam mation. Of the 480 cases, 271 had available HPV results: 239 (88.2%) were HPV negative, while 32 (11.8%) were HPV positive. Follow-up data indicated that 205 of the 480 cases were subse quently repeated, with intervals ranging from two weeks to 11 months; 165 cases (34.4%) were repeated within 4 months. Among the repeated samples, 115 cases underwent HPV retesting, and unexpectedly, 6 of these cases (5.2%) converted from initial HPV negative to positive. The time intervals for these conversions ranged from 4 to 11 months. Conclusions: This study provided institutional follow-up data on HPV cotesting for unsatisfactory ThinPrep Pap tests. Compliance with ASCCP follow-up recommendations was low (34.4%), and a small percentage (5.2%) of negative HPV results converted to positive upon retesting. These conversions may stem from initial sampling issues or new infections. It is important that women with negative HPV results in the context of UPTs adhere to ASCCP management guidelines for ongoing monitoring.

Volume

105

Issue

3

First Page

2

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