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High-Risk HPV Testing in Gynecologic Cytology: An Institutional Two Year Retrospective Review
Abstracts
S63
2016 (Table 2) showed that among the malignant cases, 3 cases from academic hospitals and 30 from community hospitals were truly unexpected diagnoses. The remaining malignant cases were mostly new malignant diagnoses with a clinical suspicion of cancer. 34 (74%) cases from academic hospitals and 55 (12%) from community hospitals met CDs criteria outlined by our institutional policy. Conclusions: Overall, our institutional code (TC66) for critical diagnoses was used increasingly by both academic and community hospitals. Pathologists at academic hospitals mainly used the TC66 code for nonneoplastic conditions, while pathologists at community hospitals predominantly used this code for malignant diagnoses, reflecting the need to satisfy communication needs with clinicians in different practice settings.
Cyto+HPV-CIN3 in size, average time to occurrence, the presence of cytopathic effect on biopsy, prior history of screening or race and age of women with the lesion. On review of negative cytology, 6 of 11 were reclassified as ASCUS+ indicating an interpreting error of 55% and a sampling error of 45%; none of the cytology positive was reclassified as NILM. On histologic examination, one case of Cyto-HPV+ was reclassified as CIN2. Conclusion: There are no significant clinical or pathologic differences between Cyto-HPV+ CIN3 and Cyto+HPV-CIN3. Cytologic sampling or interpretation remains the main reasons for discrepant cases. PST140 Patient Safety Implications for Follow-up of Women with Atypical Squamous Cells e Cannot Exclude High Grade Squamous Intraepithelial Lesion Rhonda Alexander, BS, SCT(ASCP), Kim Geisinger, MD, Dana Grzybicki, MD, PhD, Stephen Raab, MD. University of Mississippi Medical Center, Jackson, MS
Table 1
Table 2
PST139 Discrepant HPV/Cytology Co-testing Results: Are There Differences between Cytology-negative vs. HPV-negative Cervical Intra-epithelial Neoplasia? Jessica Tracht, MD, Antoinette Davis, BS, CT(ASCP), Isam-Eldin Eltoum, MD. University of Alabama at Birmingham, Birmingham, AL Introduction: The aim of this study is to compare cervical intra-epithelial neoplasia (CIN3+) following negative cytology but positive high risk Human Papillomavirus (HR-HPV) [Cyto-HPV+] testing to those following negative HR-HPV test but positive cytology (ASCUS+) [Cyto+HPV-] and assess the reason for discrepancies. Materials and Methods: We retrospectively analyzed women tested for any indication for both cytology and HPV from 2010-2013. Results were retrieved from Cerner System were analyzed with SPSS software. Cumulative risk (CR) for CIN3+ following discrepant diagnosis was calculated from the time of screening to the first biopsy. After review of surgical specimens and cytology, discrepancies were classified as sampling or interpretation error. Clinical and pathologic findings were compared between the groups using Chi Square and Fisher exact tests. Results: 15,173 women (25-95, 7.1% <30) had both HPV and cytological testing. 1184 (8.4%) had biopsies. Cytology was positive in 19.4% and HPV in 14.5% of specimens. A total of 84 CIN3+ were detected: 55 Cyto+HPV+ , 11 Cyto-HPV+, 10 Cyto+HPV- , 3 CytoHPV- , and 4 tests were unsatisfactory. The cumulative risk (95% confidence interval): Cyto+HPV+, 46% (32-66%), Cyto-HPV+ 30% (15-58%), Cyto+HPV- 12% (6-23%) and Cyto-HPV- 0.8% (0.2-3.6%). There was no significant difference between Cyto-HPV+ CIN3 and
Introduction: Cytopathology laboratories track the follow-up of patients who are diagnosed with a high-grade squamous intraepithelial lesion (HSIL) for regulatory and quality assurance purposes. If a woman has not undergone a documented tissue conformational procedure within six months, our laboratory notifies the clinical team. We examined the clinical follow-up of a sample of women with atypical squamous cells e cannot exclude HSIL (ASC-H) to determine if these women also were receiving appropriate follow-up. Materials and Methods: Our laboratory has a sole source contract with the State Public Health System to perform examination of all State Public Health Pap tests and follow-up tissue biopsy specimens. Using our laboratory information system, we performed retrospective review of all women in 2015 (n Z 102, 0.52% of all Pap tests) and 2011 (n Z 112, 0.23% of all Pap tests) who had a Pap test diagnosis of ASC-H documented in our State Public Health database. We recorded follow-up procedures, diagnoses, and time between Pap test and procedure. We correlated these primary variables with secondary variables of patient State County of origin, age, race, and previous history. Results: Table 1 shows the number of women who had a ASC-H diagnosis and colposcopic follow-up in 2015 and 2011. There was no correlation with women who had follow-up and the secondary variables. Fewer women had HSIL on follow-up in 2011 compared to 2015. Conclusions: We conclude that: 1) a significant proportion of women who have a diagnosis of ASC-H are most likely not receiving appropriate clinical care. We recommend that laboratories track ASC-H clinical followup and provide notification to clinicians if pathology follow-up is not documented and 2) the frequency of women who have ASC-H and HSIL follow-up is lower than that reported in the literature. We hypothesize that we are likely more accurately diagnosing HSIL.
Table 1
PST141 High-Risk HPV Testing in Gynecologic Cytology: An Institutional Two Year Retrospective Review Patricia Goldhoff, MD, Tara Saunders, MD. University of California San Francisco, San Francisco, CA Introduction: High-risk HPV (HR-HPV) testing is commonly utilized as a reflex test for atypical squamous cells of undetermined significance (ASC-
S64
Abstracts
US) or as a cotest in women age 30 and over and has recently been approved as a first-line screening test. HR-HPV rates in ASC-US and ASC/ SIL ratios can be used as performance metrics for individual cytopathologists and laboratories as a whole. Furthermore, these quality assurance measures are requirements for accreditation by the College of American Pathologists (CAP). Materials and Methods: All Pap test results with available reflex or cotest HR-HPV testing from January 2014-December 2015 were retrieved from the pathology and clinical laboratory information system databases. HRHPV rates were stratified by year and Bethesda category. Results: HR-HPV test results were available for 664 ASC-US Paps and 6,097 cotests. HR-HPV was detected in 28.5% and 31.5% of ASC-US reflex Paps in 2014 and 2015, respectively. Among cotests overall, HR-HPV was detected in 10.5% (2014) and 9.8% (2015), while rates of 26.9% (2014) and 20.8% (2015) were noted for cotests with ASC-US. HR-HPV was detected in 87.1% of HSIL, 59.9% of LSIL, and 6.2% of negative cotests. Cotest ASC/SIL ratios were 3.7 (2014) and 3.4 (2015). Conclusions: HR-HPV status in ASC-US Paps can be a helpful quality metric to evaluate diagnostic uncertainty. While no recommended percentage has been published, prior studies of HR-HPV positivity in ASC-US Paps have shown ranges from 29.6% to 61.8%. Some of our data falls below this range, suggesting overuse of ASC-US. ASCUSreflex Paps also tended to have higher HR-HPV rates compared to ASCUS cotests, a finding which may be related to patient age, but needs further evaluation. Although we have not adopted HR-HPV testing for primary screening, given the low rate of HPV positivity in our negative cotests, it may be useful in our patient population.
gynecologic specimens were selected. The method involves concentration by centrifugation of cells collected in Cytyc’s preservative or RPMI. The cell pellet was assessed and the adequate amount transferred to a 10mL vial of CellSolutions General Cytology Preservative. A model F50 dual stage filter was loaded into the processor and a properly labeled slide inserted frosted end down. The vial with the patient sample was poured into the filter. At the end of the cycle, the slide reappears at the slide receptacle to be fixed and stained. In a final product comparison of current versus new methods; the specimens were evaluated on cellularity, preservation, and stain quality using a score of 1-poor/low cellularity, 2-average/moderate cellularity, and 3-good/high cellularity. Results: The scores comparing the current methods to the CellSolutions method are presented in Table 1. The CellSoultions score was higher in 4 out of the five categories. This evaluation demonstrated that in the majority of cases, CellSolutions produced a better quality in graded criteria on paired slides from the patient sample. In specimen types such as bronchial (Figure 1 and 4), FNA needle rinses (Figure 3), and miscellaneous types; the CellSoultions preparations demonstrated increased cellularity and better preservation. Conclusions: The CellSolutions F50 offers a practical and less expensive alternative for thin-layer, liquid-preserved cytology.
PST142 Comparison Study of Cytology Non-Gyn Specimens Processed Using ThinPrep and Cytospin Techniques versus CellSolutions Technique Debora Smith, CT(ASCP), Antonio Espinoza, BS, Ivonne Vega, BS. Houston Methodist Hospital, Houston, TX Introduction: New techniques for preparing a microscopic slide with a thin layer of cells are regularly being introduced. Some of these new techniques are simpler to run and more cost effective. This study evaluates and compares one such method, CellSolutions to ThinPrep and Cytospin preparations. Material and Methods: In this study specimens were made from residual cellular material from 100 patient samples. Several types of Cytology non-
Table 1
Bronchoalvelolar Lavage
Thyroid Needle Rinses
S63
2016 (Table 2) showed that among the malignant cases, 3 cases from academic hospitals and 30 from community hospitals were truly unexpected diagnoses. The remaining malignant cases were mostly new malignant diagnoses with a clinical suspicion of cancer. 34 (74%) cases from academic hospitals and 55 (12%) from community hospitals met CDs criteria outlined by our institutional policy. Conclusions: Overall, our institutional code (TC66) for critical diagnoses was used increasingly by both academic and community hospitals. Pathologists at academic hospitals mainly used the TC66 code for nonneoplastic conditions, while pathologists at community hospitals predominantly used this code for malignant diagnoses, reflecting the need to satisfy communication needs with clinicians in different practice settings.
Cyto+HPV-CIN3 in size, average time to occurrence, the presence of cytopathic effect on biopsy, prior history of screening or race and age of women with the lesion. On review of negative cytology, 6 of 11 were reclassified as ASCUS+ indicating an interpreting error of 55% and a sampling error of 45%; none of the cytology positive was reclassified as NILM. On histologic examination, one case of Cyto-HPV+ was reclassified as CIN2. Conclusion: There are no significant clinical or pathologic differences between Cyto-HPV+ CIN3 and Cyto+HPV-CIN3. Cytologic sampling or interpretation remains the main reasons for discrepant cases. PST140 Patient Safety Implications for Follow-up of Women with Atypical Squamous Cells e Cannot Exclude High Grade Squamous Intraepithelial Lesion Rhonda Alexander, BS, SCT(ASCP), Kim Geisinger, MD, Dana Grzybicki, MD, PhD, Stephen Raab, MD. University of Mississippi Medical Center, Jackson, MS
Table 1
Table 2
PST139 Discrepant HPV/Cytology Co-testing Results: Are There Differences between Cytology-negative vs. HPV-negative Cervical Intra-epithelial Neoplasia? Jessica Tracht, MD, Antoinette Davis, BS, CT(ASCP), Isam-Eldin Eltoum, MD. University of Alabama at Birmingham, Birmingham, AL Introduction: The aim of this study is to compare cervical intra-epithelial neoplasia (CIN3+) following negative cytology but positive high risk Human Papillomavirus (HR-HPV) [Cyto-HPV+] testing to those following negative HR-HPV test but positive cytology (ASCUS+) [Cyto+HPV-] and assess the reason for discrepancies. Materials and Methods: We retrospectively analyzed women tested for any indication for both cytology and HPV from 2010-2013. Results were retrieved from Cerner System were analyzed with SPSS software. Cumulative risk (CR) for CIN3+ following discrepant diagnosis was calculated from the time of screening to the first biopsy. After review of surgical specimens and cytology, discrepancies were classified as sampling or interpretation error. Clinical and pathologic findings were compared between the groups using Chi Square and Fisher exact tests. Results: 15,173 women (25-95, 7.1% <30) had both HPV and cytological testing. 1184 (8.4%) had biopsies. Cytology was positive in 19.4% and HPV in 14.5% of specimens. A total of 84 CIN3+ were detected: 55 Cyto+HPV+ , 11 Cyto-HPV+, 10 Cyto+HPV- , 3 CytoHPV- , and 4 tests were unsatisfactory. The cumulative risk (95% confidence interval): Cyto+HPV+, 46% (32-66%), Cyto-HPV+ 30% (15-58%), Cyto+HPV- 12% (6-23%) and Cyto-HPV- 0.8% (0.2-3.6%). There was no significant difference between Cyto-HPV+ CIN3 and
Introduction: Cytopathology laboratories track the follow-up of patients who are diagnosed with a high-grade squamous intraepithelial lesion (HSIL) for regulatory and quality assurance purposes. If a woman has not undergone a documented tissue conformational procedure within six months, our laboratory notifies the clinical team. We examined the clinical follow-up of a sample of women with atypical squamous cells e cannot exclude HSIL (ASC-H) to determine if these women also were receiving appropriate follow-up. Materials and Methods: Our laboratory has a sole source contract with the State Public Health System to perform examination of all State Public Health Pap tests and follow-up tissue biopsy specimens. Using our laboratory information system, we performed retrospective review of all women in 2015 (n Z 102, 0.52% of all Pap tests) and 2011 (n Z 112, 0.23% of all Pap tests) who had a Pap test diagnosis of ASC-H documented in our State Public Health database. We recorded follow-up procedures, diagnoses, and time between Pap test and procedure. We correlated these primary variables with secondary variables of patient State County of origin, age, race, and previous history. Results: Table 1 shows the number of women who had a ASC-H diagnosis and colposcopic follow-up in 2015 and 2011. There was no correlation with women who had follow-up and the secondary variables. Fewer women had HSIL on follow-up in 2011 compared to 2015. Conclusions: We conclude that: 1) a significant proportion of women who have a diagnosis of ASC-H are most likely not receiving appropriate clinical care. We recommend that laboratories track ASC-H clinical followup and provide notification to clinicians if pathology follow-up is not documented and 2) the frequency of women who have ASC-H and HSIL follow-up is lower than that reported in the literature. We hypothesize that we are likely more accurately diagnosing HSIL.
Table 1
PST141 High-Risk HPV Testing in Gynecologic Cytology: An Institutional Two Year Retrospective Review Patricia Goldhoff, MD, Tara Saunders, MD. University of California San Francisco, San Francisco, CA Introduction: High-risk HPV (HR-HPV) testing is commonly utilized as a reflex test for atypical squamous cells of undetermined significance (ASC-
S64
Abstracts
US) or as a cotest in women age 30 and over and has recently been approved as a first-line screening test. HR-HPV rates in ASC-US and ASC/ SIL ratios can be used as performance metrics for individual cytopathologists and laboratories as a whole. Furthermore, these quality assurance measures are requirements for accreditation by the College of American Pathologists (CAP). Materials and Methods: All Pap test results with available reflex or cotest HR-HPV testing from January 2014-December 2015 were retrieved from the pathology and clinical laboratory information system databases. HRHPV rates were stratified by year and Bethesda category. Results: HR-HPV test results were available for 664 ASC-US Paps and 6,097 cotests. HR-HPV was detected in 28.5% and 31.5% of ASC-US reflex Paps in 2014 and 2015, respectively. Among cotests overall, HR-HPV was detected in 10.5% (2014) and 9.8% (2015), while rates of 26.9% (2014) and 20.8% (2015) were noted for cotests with ASC-US. HR-HPV was detected in 87.1% of HSIL, 59.9% of LSIL, and 6.2% of negative cotests. Cotest ASC/SIL ratios were 3.7 (2014) and 3.4 (2015). Conclusions: HR-HPV status in ASC-US Paps can be a helpful quality metric to evaluate diagnostic uncertainty. While no recommended percentage has been published, prior studies of HR-HPV positivity in ASC-US Paps have shown ranges from 29.6% to 61.8%. Some of our data falls below this range, suggesting overuse of ASC-US. ASCUSreflex Paps also tended to have higher HR-HPV rates compared to ASCUS cotests, a finding which may be related to patient age, but needs further evaluation. Although we have not adopted HR-HPV testing for primary screening, given the low rate of HPV positivity in our negative cotests, it may be useful in our patient population.
gynecologic specimens were selected. The method involves concentration by centrifugation of cells collected in Cytyc’s preservative or RPMI. The cell pellet was assessed and the adequate amount transferred to a 10mL vial of CellSolutions General Cytology Preservative. A model F50 dual stage filter was loaded into the processor and a properly labeled slide inserted frosted end down. The vial with the patient sample was poured into the filter. At the end of the cycle, the slide reappears at the slide receptacle to be fixed and stained. In a final product comparison of current versus new methods; the specimens were evaluated on cellularity, preservation, and stain quality using a score of 1-poor/low cellularity, 2-average/moderate cellularity, and 3-good/high cellularity. Results: The scores comparing the current methods to the CellSolutions method are presented in Table 1. The CellSoultions score was higher in 4 out of the five categories. This evaluation demonstrated that in the majority of cases, CellSolutions produced a better quality in graded criteria on paired slides from the patient sample. In specimen types such as bronchial (Figure 1 and 4), FNA needle rinses (Figure 3), and miscellaneous types; the CellSoultions preparations demonstrated increased cellularity and better preservation. Conclusions: The CellSolutions F50 offers a practical and less expensive alternative for thin-layer, liquid-preserved cytology.
PST142 Comparison Study of Cytology Non-Gyn Specimens Processed Using ThinPrep and Cytospin Techniques versus CellSolutions Technique Debora Smith, CT(ASCP), Antonio Espinoza, BS, Ivonne Vega, BS. Houston Methodist Hospital, Houston, TX Introduction: New techniques for preparing a microscopic slide with a thin layer of cells are regularly being introduced. Some of these new techniques are simpler to run and more cost effective. This study evaluates and compares one such method, CellSolutions to ThinPrep and Cytospin preparations. Material and Methods: In this study specimens were made from residual cellular material from 100 patient samples. Several types of Cytology non-
Table 1
Bronchoalvelolar Lavage
Thyroid Needle Rinses