Background:
The authors have noted that in cervical cytology specimens from perimenopausal and postmenopausal women, the diagnosis of atypical squamous cells of undetermined significance (asc-us), as defined in the bethesda system, is often not associated with a clinically evident lesion on follow-up. reflex human papillomavirus (hpv) testing provides an opportunity to distinguish cytologic features of significance from those within the spectrum of benign cellular change in this age group.
Methods:
Liquid-based preparations that were diagnosed as asc-us between january 2003 and july 2005 at emory university hospital were identified from the computer files. the results of hpv-dna testing were recorded. two hundred four papanicolaou tests from perimenopausal women (n = 81, 40-49 years) and postmenopausal women (n = 123, >50 years) were reviewed in a blinded fashion.
Results:
Hpv-dna results were available for 903 of 1044 patients diagnosed as asc-us. overall, 323 results (35.8%) were positive, 510 results (56.6%) were negative, and 70 results (7.8%) were indeterminate. in addition, 73% of asc-us specimens in patients aged > or =40 years were negative for hpv dna. the hpv-dna detection rate dropped from 60% in the group ages 10 to 19 years to approximately 18% in the group aged >50 years. a review of hpv-negative cases in the group aged >40 years showed squamous cells with random nuclear enlargement and slight hyperchromasia that likely were interpreted as asc-us (based on the cells that were dotted by the original reviewer). nuclear grooves were frequent in these nuclei; and cytoplasmic halos, when present, usually were perinuclear.
Conclusions:
Hpv-dna detection in cervical cytology specimens has an inverse relation to patient age. a diagnosis of asc-us in perimenopausal and postmenopausal women is likely to result in a negative hpv-dna test in a significant proportion of patients. enlarged nuclei with nuclear grooves and slight hyperchromasia are possibly the cause of asc-us overdiagnosis in this age group.