Physicians turn to HPV testing in women with AGUS Pap results.(Gynecology)

VANCOUVER, CANADA -- When Kaiser Permanente instituted testing for human papillomavirus in 2001, physicians were instructed not to test for the virus as a way to triage patients with Pap results showing atypical glandular cells of undetermined significance.

Clinicians "paid no attention whatsoever" to this guideline, however, resulting in data on 877 women with atypical glandular cells of undetermined significance (AGUS) smears who underwent testing for the human papillomavirus (HPV) and biopsies, Walter Kinney, M.D., said at the 22nd International Papillomavirus Conference.

National guidelines recommend HPV testing in two situations: to help manage women with Pap smears showing atypical squamous cells of undetermined significance (ASCUS), or as cotesting with Pap smears for cervical screening in women older than 30 years.

HPV tests were positive in 33% of the women with AGUS. Of these, 33% had cervical intraepithelial neoplasia grades 2/3 or higher (CIN 2/3+). Among HPV-negative women, 3% had CIN 2/3+, said Dr. Kinney of the Permanente Medical Group, Sacramento.

Of more interest to investigators were the women whose initial colposcopies produced negative biopsy results. Their HPV status at the time of AGUS diagnosis was more predictive than biopsy results of the likelihood of developing cervical abnormalities during a 12-month follow-up, he said at the conference, sponsored by the University of California, San Francisco.

Among 95 women who were initially HPV positive but had negative biopsies, 24 (25%) developed CIN 2/3+ during follow-up. None of 260 women who were HPV negative with benign biopsies at their initial evaluation developed CIN 2/3+.

The lead investigator in this study was Barbara Fetterman, Ph.D., of the Permanente Medical Group, Oakland, Calif. In a poster presentation at ...