Goyal Abha, Street Jessica, Alperstein Susan A, Siddiqui Momin T
Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York.
Diagn Cytopathol. 2018 Nov;46(11):914-918. doi: 10.1002/dc.23989. Epub 2018 Oct 24.
High-risk human papillomavirus (HPV) test ordering has evolved since the 2006 ASCCP guidelines. In light of the availability of the HPV test results for most women ≥30 y, regardless of the Pap test diagnosis; we examined their value in assessing the overall performance of cytopathologists (CPs).
Data were derived for six CPs for Pap test interpretations over 4 y. HPV positivity rates for atypical squamous cells of undetermined significance (ASC-US) and for patients ≥30 y for negative for intraepithelial lesion or malignancy (NILM) and squamous intraepithelial lesion (SIL) (inclusive of low grade SIL (LSIL), high grade SIL (HSIL), and carcinoma) categories were retrieved for individual CPs. ASC/SIL ratios were analysed overall and separately for patient groups <30 y and ≥30 y. Pearson correlation coefficient was calculated to assess correlation between HPV positivity rates for ASC-US, NILM and SIL, and ASC/SIL ratios.
The overall ASC-US HPV positivity rate was 41%-49% for patients <30 y, 32% for patients ≥30 y. Stratifying by patient age group, ASC-US HPV positivity rate, and ASC/SIL ratio showed a negative correlation. Excluding an outlier, the NILM HPV positivity rate and ASC/SIL ratio showed a strong negative correlation.
Our study shows that ASC-US HPV positivity rate is dependent on the age of the population that is tested. Monitoring of the HPV positivity rates for NILM and SIL categories can serve as an additional objective measure to assess the performance of CPs. Based on the patient population, the laboratory can establish an initial baseline for these rates and use it to adjust interpretive thresholds in ensuring the diagnostic sensitivity of the test and the quality of the interpretation.
自2006年美国阴道镜及宫颈病理学会（ASCCP）指南发布以来，高危型人乳头瘤病毒（HPV）检测的应用情况有所变化。鉴于大多数30岁及以上女性均可获得HPV检测结果，而不论巴氏试验诊断结果如何；我们研究了这些结果在评估细胞病理学家（CPs）整体表现方面的价值。
收集了6位CPs在4年期间对巴氏试验的解读数据。获取了个别CPs对意义不明确的非典型鳞状细胞（ASC-US）、30岁及以上上皮内病变或恶性病变阴性（NILM）以及鳞状上皮内病变（SIL，包括低级别SIL（LSIL）、高级别SIL（HSIL）和癌）患者的HPV阳性率。总体分析了ASC/SIL比率，并分别针对年龄<30岁和≥30岁的患者组进行分析。计算Pearson相关系数以评估ASC-US、NILM和SIL的HPV阳性率与ASC/SIL比率之间的相关性。
年龄<30岁患者的总体ASC-US HPV阳性率为41%-49%，30岁及以上患者为32%。按患者年龄组分层，ASC-US HPV阳性率与ASC/SIL比率呈负相关。排除一个异常值后，NILM HPV阳性率与ASC/SIL比率呈强负相关。
我们的研究表明，ASC-US HPV阳性率取决于所检测人群的年龄。监测NILM和SIL类别的HPV阳性率可作为评估CPs表现的一项额外客观指标。根据患者人群，实验室可为这些比率建立初始基线，并用于调整解读阈值，以确保检测的诊断敏感性和解读质量。
