UPDATE: ASCCP HPV Test Algorithm

Update: ASCCP HPV Test Algorithm

By: Ronald Tickman, M.D., Director, Cytopathology and FNA Clinic
and Christina Isacson, M.D., Gynecologic Pathologist

Testing for high-risk human papillomavirus (HPV) DNA has proven to be very useful in cervical cancer screening and management of patients with cervical neoplasia. Appropriate use of this test is critical not only to avoid unnecessary over utilization but to avoid over treatment of some women. The American Society for Colposcopy and Cervical Pathology (ASCCP) has published consensus management guidelines on this issue which have been widely endorsed by other professional societies. CellNetix Laboratories has modified our reflexive testing algorithm for high-risk HPV to more closely align with the ASCCP guidelines. Our new algorithm for reflexive high-risk HPV testing will be limited to liquid based Pap tests interpreted as atypical squamous cells of undetermined significance (ASCUS). Cases with other interpretations will not be tested for high-risk HPV unless otherwise requested. In some patients it may be appropriate to perform testing outside of the guidelines and in these situations the ordering physician’s request will be followed.

The ASCCP guidelines for reflexive high-risk HPV DNA testing are summarized below:

1. Atypical squamous cells of uncertain significance (ASCUS): HPV testing is recommended for women 21 years of age or older, but not on younger women.

2. Low grade squamous intraepithelial lesion (LSIL): HPV testing is recommended for postmenopausal women but not for premenopausal women. Postmenopausal women with LSIL cytology and negative high-risk HPV DNA testing are at low risk for cervical cancer and do not need colposcopy.

3. High grade squamous intraepithelial lesion (HSIL): HPV testing is not appropriate, because all of these patients should receive colposcopy.

4. Atypical squamous cells cannot exclude HSIL (ASCH) and atypical glandular cells (AGC):HPV testing is not to be used for triage to decide whether to refer to colposcopy; however, HPV testing may be appropriate to guide post-colposcopy management when the initial colposcopy does not identify a high grade lesion.

HPV testing guidelines will continue to evolve as more studies are reported, however at this time we would like to promote the use of the current ASCCP guidelines to provide the most cost effective treatment and minimize the risk of patient harm.