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The Importance of Human Papillomavirus 16/18 Genotype Risk Stratification in Atypical Squamous Cells of Undetermined Significance in an Inner-City Urban Hospital

INTRODUCTION: Cervical cancer screening has changed dramatically. However, appropriate triaging of abnormal Pap test results is still debatable. This is true for an atypical squamous cells of undetermined significance (ASCUS) Pap test result. The objective of this study was to determine prevalence of cervical pathology in ASCUS Pap test results in an inner-city population and to determine if knowledge of human papillomavirus (HPV) subtype 16/18 is useful in predicting cervical dysplasia. METHODS: A descriptive cross-sectional population study was conducted of patients with an ASCUS Pap test result between January 2012 and May 2013. Data were collected on HPV status, HPV subtype, and cervical biopsy results. RESULTS: Two hundred fifty-nine patients had an ASCUS Pap test result. A total of 15.8% (n=41) had an unknown HPV status. A total of 37.4% (n=97) were HPV-negative. A total of 46.7% (n=121) were HPV-positive. Of those who were HPV-positive, 63.6% (n=76) were high-risk HPV-positive but did not have a 16/18 genotype. A total of 29.75% (n=36) were HPV 16/18-positive. Eighty-seven patients had a colposcopy and 20.7% (n=18) had a cervical biopsy. A total of 44.4% revealed no dysplasia; 33.3% had cervical intraepithelial neoplasia (CIN) I and 22.2% had CIN II or III. Eighteen patients who had 16/18 positivity had a colposcopy and 27.8% (n=5) had CIN I or II. CONCLUSION: Patients with an ASCUS Pap test result have a higher chance of being HPV-positive. A total of 8.3% of patients with positive high-risk HPV regardless of genotype had CIN. Almost 30% of those patients with HPV positivity for 16/18 had cervical dysplasia. Colposcopy should be done if the patient has high-risk HPV regardless of subtype, but if a patient is 16/18-positive, then the chance of cervical dysplasia increases dramatically.