The use of reflex high-risk human papillomavirus testing for atypical squamous cells of undetermined significance interpretations on vaginal specimens

BACKGROUND: The use of reflex high-risk human papillomavirus (hrHPV) testing as a triage method for cervical specimens with an interpretation of atypical squamous cells of undetermined significance (ASC-US) is well established. To the authors' knowledge, very little has been reported regarding the utility of this approach in vaginal specimens in women with a prior hysterectomy. The current study evaluated the results of hrHPV testing in women with vaginal specimens interpreted as ASC-US in the authors' laboratory. METHODS: Follow-up information, including results of hrHPV testing, was sought for all vaginal smears reported as ASC-US from the authors' cytology laboratory during the calendar years 2005 and 2006. RESULTS: For the 2 years reviewed, 254 ASC-US vaginal specimens were available for assessment. Reflex hrHPV testing was requested on 236 (92.9%), with sufficient residual material available in 193 specimens. hrHPV was detected in 44 (22.8%). Follow-up results were available for 136 specimens, with a squamous intraepithelial lesion (SIL, all but 1 of which was low grade) found to be present in 21 (15.4%). SIL was identified in significantly more women in whom hrHPV was detected compared with those in whom hrHPV was not detected (41.9% vs 4.2%; P < .001 by the Fisher exact test). CONCLUSIONS: Rates of detection of squamous abnormalities in women with ASC-US on vaginal preparations in whom hrHPV was detected were found to be higher than in those without hrHPV. These findings suggest that clinical follow-up is needed for women in whom hrHPV is detected. hrHPV testing may be clinically useful as a method of triage for women with ASC-US vaginal smears.