AJCP Highlight: HPV Testing and Pap Test Interpretation

May 07, 2018

Cervical cancer continues to be a major public health challenge, with more than 12,000 new cases diagnosed every year in the United States. The majority of cervical cancer cases are associated with persistent infection with one of the high-risk human papillomaviruses (HPV-HR). The Papanicolaou (Pap) test is undoubtedly one of the biggest success stories in the history of preventive medicine, allowing early identification with subsequent treatment of the precancerous lesions of the cervix, according to Avani A. Pendse, MD, PhD, et al., in an article titled, “Increased Rate of ASCUS Diagnosis With Concomitant Request for High-Risk Human Papillomavirus Reflex Testing May Be Due to Cognitive Bias” which appeared in the May issue of AJCP.

The most commonly made abnormal diagnosis on a Pap test is “atypical squamous cells of uncertain significance” (ASCUS). The recommended management of women with a diagnosis of ASCUS by Pap test is follow-up testing for HPV-HR to determine further management. HPV-HR reflex testing may be concomitantly requested at the time of the Pap test for a resultant ASCUS diagnosis, or subsequently requested following the ASCUS diagnosis. When HPV-HR reflex testing is ordered concomitantly at the time of the Pap test, the cytopathologist may be aware of the HPV-HR reflex testing request at the time of the cytomorphologic interpretation of the Pap test.

Currently, there are limited data in the literature that report the impact of a concomitant HPV-HR reflex testing request with the initial Pap test order on the cytomorphologic interpretation of the Pap test, and any subsequent effects on clinical practice and patient outcome. Peng and Wang reported that a request for HPV-HR reflex testing “might have had a small, but insignificant” impact on the cytopathologists’ interpretation of the ThinPrep Pap tests, but did not influence the subsequent clinical management of an ASCUS diagnosis. Find out more about Dr. Pendse’s study by reading the AJCP article here.