S. Deblina Datta, MD; Hillard Weinstock, MD, MPH
Potential Financial Conflicts of Interest: None disclosed.
Datta SD, Weinstock H. The Prevalence of High-Risk Human Papillomavirus in Women with Different Types of Cervical Cancer. Ann Intern Med. 2008;149:283. doi: 10.7326/0003-4819-149-4-200808190-00015
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Published: Ann Intern Med. 2008;149(4):283.
The prevalence of HPV DNA in LSIL and HSIL is known to be very high; therefore, management decisions are based on the presence of the cytologic abnormality alone. The management of LSIL (referral for colposcopy) and that of HSIL (loop electrosurgical excision procedure) are similar in that procedural evaluations are needed (with the exception of special patient populations) and HPV DNA testing would not influence management. The management of atypical squamous cells of undetermined significance (ASC-US), however, is dependent on the results of HPV DNA testing (1). The ALTS (Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesion Triage Study) trial demonstrated the utility of HPV DNA testing as a triage strategy in the management of ASC-US (but not LSIL) for all women (2), and the American Society for Colposcopy and Cervical Pathology (ASCCP) recommended this strategy in their 2001 guidelines (3). The 2006 ASCCP guidelines have been amended to exclude cases of ASC-US in adolescents (age <21 years) from HPV DNA triage because of the high prevalence of HPV infections and low risk for cancer in this age group. Therefore, in our original report, we chose to present prevalence among persons with ASC-US Papanicolaou tests with more detail by age, in order to inform the debate about optimal age cutoffs for HPV DNA triage. We encountered relatively few cases of LSIL or HSIL; therefore, we combined the categories.
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