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High-Grade Squamous Intraepithelial Lesion Cytology With Negative High-Risk Human Papillomavirus Tests Rarely Diagnoses Endometrial Cancer

Pretorius, Robert G. MD; Peterson, Patricia

Journal of Lower Genital Tract Disease: July 2015 - Volume 19 - Issue 3 - p 200–202
doi: 10.1097/LGT.0000000000000072
Original Articles - Cervix and HPV

Objectives: We hypothesized that women with cervical cytologic results of high-grade squamous intraepithelial lesion (HSIL) and negative high-risk human papillomavirus (HR-HPV) test results would have a high risk of having endometrial cancer and would benefit from routine endometrial biopsy.

Materials and Methods: Reports of women with cytologic results of HSIL and negative HR-HPV test results were found in an electronic colposcopy database; their charts were reviewed. Rates of endometrial cancer for cytologic results of HSIL and negative HR-HPV test results were compared to a historical series for cytologic results of HSIL with positive HR-HPV and cytologic results of atypical glandular cells (AGCs) and negative HR-HPV test results.

Results: Between August 10, 1998, and April 20, 2013, 56 women were evaluated in our colposcopy clinics for cytologic results of HSIL and negative HR-HPV test results; of these 56 women, 1 (1.8%) was diagnosed with endometrial cancer. No endometrial cancer was diagnosed during the follow-up (median = 63 mo) after colposcopy. The risk for endometrial cancer with cytologic results of HSIL and negative HR-HPV test results (1.8%, 1/56) did not differ from that of a historical series from 2007 to 2009 from the same colposcopy clinic in 223 women with cytologic results of HSIL and positive HR-HPV test results (0.0%, 0/223; p = .2) and was lower than the risk for endometrial cancer from the historical series from 2007 to 2009 in women with cytologic results of AGC and negative HR-HPV test results (14.4%, 4/27; p = .04).

Conclusions: Women with cytologic results of HSIL and negative HR-HPV test results are more like those with cytologic results of HSIL and positive HR-HPV test results than those with cytologic results of AGC and negative HR-HPV test results and would unlikely to benefit from routine endometrial biopsy at the time of colposcopy.

Women with cytologic results of high-grade squamous intraepithelial lesions with negative high-risk human papillomavirus test results have a low risk (1.8%) of having endometrial cancer.

Department of Obstetrics and Gynecology, S.C.P.M.G.-Fontana, Fontana, CA

Correspondence to: Robert G. Pretorius, MD, Department of Obstetrics and Gynecology, S.C.P.M.G.-Fontana, 9961 Sierra Ave, Fontana, CA 92335. E-mail: Robert.G.Pretorius@kp.org

There is no funding source for this work.

The authors have declared they have no conflicts of interest.

Copyright © 2015 by the American Society for Colposcopy and Cervical Pathology