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How would you treat these women?

Patient Case Study 1

A female 28-year-old GO presents with a history of ASC-US Pap and positive hrHPV result.

A female 28-year-old GO presents with a history of borderline cytology (ASC-US) and previous positive hrHPV result

The colposcopy fails to reveal any lesions.

What do the NHSCSP guidelines say to do?

NHSCSP guidelines:1

NHSCSP suggests that women with borderline cytology (ASC-US) who are hrHPV+ be referred for colposcopy.1

HPV testing to triage borderline cytology (ASC-US) and low-grade dyskaryosis in women ≥25 years.

  • hrHPV+ women should be referred for colposcopy:
    • Those with negative colposcopy, no biopsy, or biopsy with no CIN on borderline or mild dyskaryosis cytology and hrHPV+ are recommended to be discharged to routine 3 or 5 year recall, depending on their age.
    • Those with CIN1 not requiring treatment should receive repeat cytology at 12 months with or without  colposcopy, if cytology is borderline repeat hrHPV triage is required.
    • Those with ≥CIN2 should be managed per NHSCSP guidelines.
  • hrHPV- women are recommended to be discharged to routine 3 or 5 year recall, depending on their age.


Absolute risk of CIN2 according to genotype

  • The cobas® HPV Test helps you follow the guidelines by providing pooled hrHPV results. 
  • The cobas® HPV Test also provides individual HPV 16 and HPV 18 results to help you identify those women at highest risk who may need more intensive postcolposcopic follow-up.

 

Absolute risk of ≥CIN2 stratified by hrHPV status in the ATHENA NILM population2

 

Discover a woman's risk for ≥CIN2 or  find a lab near you that offers the  cobas® HPV Test. 

 

Patient Case Study 2

A female 32-year-old G1P1 presents for routine screening.

A female 32-year-old G1P1 presents for routine screening. 

Her prior cervical cytology was 4 years ago and was reported as negative. Her current cytology is also negative, but she requested a private HPV test and  tested hrHPV+. What do the guidelines say?

NHSCSP guidelines:

  • NHSCSP states that women with borderline or mild dyskaryosis, borderline/high-grade or borderline endocervical cells and hrHPV+ should be referred to colposcopy.
  • hrHPV- women should be referred to routine 3 and 5 year recall.

ACOG, ASCCP, ASCP and ACS guidelines:3

  • In addition ACOG states that HPV DNA tests specific for HPV types 16 and HPV 18 can be used as an adjunct in women with negative cytology test results, but who have tested positive for hrHPV by an assay testing for 13 or 14 high-risk types, in women 30 years or older.4
  • Moreover, new professional guidelines from the ASCCP, ASCP and ACS suggest that women with normal cytology who are HPV 16+ or HPV 18+ be considered for immediate colposcopy.5

 Review detailed recommendations from the UK guidelines.

Review recommendations from the ACOG, ASCCP, ASCP and ACS.

Role of genotyping when screening5

ACOG, ASCCP, ASCP and ACS now recommend that in women 30-65 years of age, individual genotyping for HPV 16 or HPV 16 and 18 be considered when women have a normal cytology screening result but have positive results on a test for “pooled” hrHPV types. 

Absolute risk of high-grade cervical disease in women with normal cytology

The cobas® HPV Test enables adherence to the guidelines by providing pooled hrHPV results and identifies the individual presence of HPV 16 and HPV 18, the highest-risk genotypes.


Absolute risk of ≥CIN2 stratified by hrHPV status in the ATHENA ASC-US population6

   

Discover a woman's risk for ≥CIN2 or  find a lab near you that offers the  cobas® HPV Test. 

 
 
  • Acronyms:

References:

1. American Society for Colposcopy and Cervical Pathology. HPV Genotyping Clinical Update. http://www.asccp.org/ConsensusGuidelinesHPVGenotypingClinicalUpdate/tabid/5963/Default.aspx. Accessed June 2011.

2. Stoler MH, Wright TC, Sharma A, et al. High-risk human papillomavirus testing in women with ASC-US cytology: results from the ATHENA HPV study. Am J Clin Pathol. 2011;135(3):468-475

3. The American Congress of Obstetricians and Gynecologists. ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists: Screening for Cervical Cancer. November, 2012

4. Saslow D et al, Journal of Lower Genital Tract Disease, Volume 16, Number 3, 2012

5. Wright TC Jr, Stoler MH, Sharma A, Zhang G, Behrens CM, Wright TL. Evaluation of HPV-16 and HPV-18 genotyping for the triage of women with high-risk HPV+ cytology-negative results. Am J Clin Pathol. 2011;136:578-586