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Researchers Urge Restraint in Ordering HPV Tests.
NASHVILLE, TENN. -- Physicians may be tempted to test for human papillomavirus in patients whose Pap smear results indicate atypical squamous cells of undetermined significance, given the findings of a recent large study.
Nevertheless, physicians should seriously consider performing a repeat Pap smear instead of testing for human papillomavirus (HPV), Dr. Sara Hughes advised at the annual meeting of the Society of Gynecologic Oncologists.
"I'm concerned that before there is some agreement on how and when to use the HPV test, there will be a lot of unnecessary procedures done as a result of a positive HPV result simply because providers feel nervous about the positive result," Dr. Hughes, a resident in obstetrics and gynecology at Brigham and Women's Hospital in Boston, told this newspaper.
HPV testing for a Pap smear result of atypical squamous cells of undetermined significance (ASCUS) got a boost from the recently published ASCUS/LSIL Triage Study (ALTS). The study found that HPV testing was more sensitive in detecting underlying high-grade lesions than was a repeat Pap smear in women with a previous ASCUS result (96% vs. 85%) (J. Natl. Cancer Inst. 93[4]:293-99, 2001).
Dr. Hughes said that a patient at her institution exemplifies the overmanagement that can result from a positive HPV test. Despite having normal colposcopy and biopsy results after testing positive for HPV, the patient was sent for a more in vasive investigation because both she and her physician were worried about the HPV result.
In a study presented by Dr. Hughes at the meeting, HPV testing identified virtually all high-grade lesions, but it also had a high false-positive rate. "Of all of the women who are positive for HPV, only 1 out of 10 of them will have a high-grade lesion. The rest of the women will be entirely normal," she said.
The retrospective study of 419 cases focused on 208 ASCUS samples, all of which had also been tested for high-risk HPV.
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