A Study of Partial Human Papillomavirus Genotyping in Support of the 2019 ASCCP Risk-Based Management Consensus Guidelines

Maria Demarco, Didem Egemen, Tina R. Raine-Bennett, Li C. Cheung, Brian Befano, Nancy E. Poitras, Thomas S. Lorey, Xiaojian Chen, Julia C. Gage, Philip E. Castle, Nicolas Wentzensen, Rebecca B. Perkins, Richard S. Guido, Mark Schiffman

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Abstract

INTRODUCTION: The 2019 ASCCP Risk-Based Management Consensus Guidelines include recommendations for partial human papillomavirus (HPV) genotyping in management of abnormal cervical cancer screening results. The guidelines are based on matching estimates of cervical intraepithelial neoplasia (CIN) 3+ risk to consensus clinical action thresholds. In support of the guidelines, this analysis addresses the risks predicted by individual identification of HPV 16 and HPV 18. METHODS: Risk estimates were drawn from a subset of women in the Kaiser Permanente Northern California screening program, whose residual cervical specimens were HPV typed as part of the HPV Persistence and Progression study. We calculated risk of CIN 3+ to assess how identification of HPV 16, HPV 18, or 12 other "high-risk" HPV types would influence recommended clinical management of new abnormal screening results, taking into account current cytologic results and recent screening history. Immediate and/or 5-year risks of CIN 3+ were matched to clinical actions identified in the guidelines. RESULTS: Identification of HPV 16 at the first visit including HPV testing elevated immediate risk of diagnosing CIN 3+ sufficiently to mandate colposcopic referral even when cytology was Negative for Intraepithelial Lesions or Malignancy and to support a preference for treatment of cytologic high-grade squamous intraepithelial lesion. HPV 18 less clearly elevated CIN 3+ risk. CONCLUSIONS: Identification of HPV 16 clearly mandated consideration in clinical management of new abnormal screening results. HPV 18 positivity must be considered as a special situation because of established disproportionate risk of invasive cancer. More detailed genotyping and use beyond initial management will be considered in guideline updates.

Original languageEnglish (US)
Pages (from-to)144-147
Number of pages4
JournalJournal of lower genital tract disease
Volume24
Issue number2
DOIs
StatePublished - Apr 1 2020

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ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Demarco, M., Egemen, D., Raine-Bennett, T. R., Cheung, L. C., Befano, B., Poitras, N. E., Lorey, T. S., Chen, X., Gage, J. C., Castle, P. E., Wentzensen, N., Perkins, R. B., Guido, R. S., & Schiffman, M. (2020). A Study of Partial Human Papillomavirus Genotyping in Support of the 2019 ASCCP Risk-Based Management Consensus Guidelines. Journal of lower genital tract disease, 24(2), 144-147. https://doi.org/10.1097/LGT.0000000000000530