Bruner Kathy S, Davey Diane D
Department of Pathology and Laboratory Medicine, University of Kentucky Medical Center, Lexington, Kentucky 40536, USA.
Diagn Cytopathol. 2004 Nov;31(5):358-61. doi: 10.1002/dc.20144.
High-risk human papillomavirus (HPV) DNA triage is commonly performed for cervical cytology specimens interpreted as atypical squamous cells of undetermined significance (ASC-US), but little is known about testing results in women > or =40 yr of age. The extent to which clinical follow-up after HPV testing reflects the most recent management guidelines is unknown also. Data from 108 patients > or =40 yr of age with concurrent (93 patients) or recent (15 patients) ASC-US interpretations and HPV testing were reviewed. Twenty-five (23.1%) of these patients were positive for high-risk HPV. The HPV(+) rate was higher in women with a current interpretation of ASC-US (26.9%) compared with those with a previous ASC-US result (0%). Many patients were not managed exactly according to the "2001 Consensus Guidelines for the Management of Women with Cervical Cytologic Abnormalities." The majority (52.6%) of women with HPV(+) ASC-US did not receive colposcopy in our institution, and 41.3% of women with HPV(-) ASC-US received follow-up testing within 8 mo. These results show the potential for inadequate evaluation of women with HPV(+) ASC-US, as well as unnecessary early repeat cytology in HPV(-) ASC-US patients. Therefore, additional clinician education and reminders to correlate cytology and HPV test results may be warranted to optimize patient care.
高危型人乳头瘤病毒（HPV）DNA分流检测通常用于对宫颈细胞学标本解读为意义不明确的非典型鳞状细胞（ASC-US）的情况，但对于40岁及以上女性的检测结果了解甚少。HPV检测后的临床随访在多大程度上符合最新管理指南也尚不清楚。回顾了108例年龄在40岁及以上、同时（93例）或近期（15例）有ASC-US解读且进行了HPV检测的患者的数据。其中25例（23.1%）患者高危型HPV呈阳性。当前解读为ASC-US的女性中HPV阳性率（26.9%）高于既往有ASC-US结果的女性（0%）。许多患者并未严格按照“2001年宫颈细胞学异常女性管理共识指南”进行处理。在我们机构中，大多数（52.6%）HPV阳性的ASC-US女性未接受阴道镜检查，41.3%HPV阴性的ASC-US女性在8个月内接受了随访检测。这些结果表明，HPV阳性的ASC-US女性可能存在评估不足的情况，HPV阴性的ASC-US患者可能存在不必要的早期重复细胞学检查。因此，可能需要对临床医生进行更多教育并提醒其将细胞学和HPV检测结果相关联，以优化患者护理。
