Data from Risk of Precancer Determined by HPV Genotype Combinations in Women with Minor Cytologic Abnormalities

Abstract

<div>Abstract<p><b>Background:</b> Studies suggest that testing for individual human papillomavirus (HPV) genotypes can improve risk stratification in women with minor cytologic abnormalities. We evaluated genotyping for HPV16, HPV16/18, and HPV16/18/45 in carcinogenic HPV-positive women with atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) cytology.</p><p><b>Methods:</b> For women enrolled in the ASCUS–LSIL Triage Study (ALTS), we calculated the age-stratified (<30 and 30+ years) positivity and cumulative risk over two years of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) when testing positive or negative for three genotype combinations: HPV16, HPV16/18, and HPV16/18/45.</p><p><b>Results:</b> Among women with ASCUS cytology, HPV16 positivity was 17.1% and increased to 22.0% (<i>P</i> < 0.001) for HPV16/18 and 25.6% (<i>P</i> < 0.001) for HPV16/18/45. Among women with LSIL cytology, HPV16 positivity was 21.1% and increased to 30.0% (<i>P</i> < 0.001) for HPV16/18 and 34.0% (<i>P</i> = 0.017) for HPV16/18/45. Regardless of cytology and age group, the greatest risk difference between test positives and test negatives was observed for HPV16 with decreasing risk stratification for HPV16/18 and HPV16/18/45. However, testing negative for any of the three combinations while being positive for another carcinogenic type still implied a two-year risk of CIN3+ of 7.8% or more.</p><p><b>Conclusions:</b> Although genotyping for HPV16, 18, and 45 provided additional risk stratification in carcinogenic HPV-positive women with minor cytologic abnormalities, the risk among genotype-negative women was still high enough to warrant immediate colposcopy referral.</p><p><b>Impact:</b> HPV genotyping in HPV-positive women with minor cytologic abnormalities will likely not alter clinical management. Adding HPV45 to genotyping assays is not warranted. <i>Cancer Epidemiol Biomarkers Prev; 22(6); 1095–101. ©2013 AACR</i>.</p></div>