Three-Year Follow-up for Women 30 Years and Older with Negative Pap and Negative Hybrid Capture 2 HPV DNA Testing Results

this difference was not statistically significant and the risk of detecting CIN 2+ after a diagnosis of ASC-H in women older than 50 was sufficiently high to clinically warrant referral to colposcopy. HPV testing was performed at the request of the clinician in 127 (25.1%) of all ASC-H cases, with 83 cases (65.4%) testing positive for HPV. When subcategorized by age, 70.4% of 98 women age 50 and younger were HPV-positive, while this proportion in the 29 women above 50 years of age was 48.3%. Although this percentage was significantly lower as confirmed by chi-square testing (p<0.05), the prevalence of HPV in women over 50 was not negligible. Finally, there were only 38 patients for whom both HPV testing results and histologic follow-up were available. Of these, 24 were HPV-positive and 14 were HPV-negative. In the HPV-positive group, approximately half (54.2%) were found to have CIN 2+ on subsequent biopsy, and this proportion was roughly maintained when subcategorized by age. However, in the HPV-negative group, only one 35-year-old woman had CIN 2 on histologic follow-up, and none of the 7 women above age 50 were found to have CIN 2+. Conclusions: This study reaffirms previous reports that both prevalence of HPV and risk of CIN 2+ decrease with age. Furthermore, among patients for whom both HPV results and histologic follow-up were available, none of the women over age 50 who tested negative for HPV had CIN 2+ on biopsy. This finding suggests that by reflex HPV testing in older patients with a cytology diagnosis of ASC-H, colposcopy may be avoided in those who are HPV-negative. Similar studies on a larger scale may support modifying the 2006 Management Guidelines to include reflex HPV testing on all cases of ASC-H and possibly avoiding colposcopy in HPV-negative women.