The Association Between Papanicolaou Test Results and Immunohistochemistry Test Utilization in the Diagnosis of Cervical Precancers 公开
Hunt, Hillary (Spring 2019)
Published
Abstract
Background: In the United States, cervical cancer screening recommendations today consist of cytology-based screening every three years in women ages 21-65 or may be every five years in women 30 and older with high-risk HPV testing alone or in combination with cytology. Women with abnormal cytology are triaged to further testing to determine management of potentially precancerous cervical lesions. Immunohistochemistry (IHC) is becoming increasingly common in diagnosing precancerous cervical lesions. The results of IHC testing influence the clinical management of lesions, but there has been little research into its practical implementation, particularly clinical or demographic factors associated with its usage.
Methods: Cross-sectional data from the Human Papillomavirus (HPV) Vaccine Impact Monitoring Project (HPV-IMPACT) was used to evaluate the association between Papanicolaou (Pap) testing results and the usage of IHC testing among women ages 18-39 in five Emerging Infections Program (EIP) sites in the United States diagnosed with cervical precancers. Descriptive statistics were generated, and a logistic regression analysis was used to estimate the association between Pap results and IHC testing, adjusting for presence of high-risk HPV, site, and final diagnosis.
Results: A total of 4,675 cases of CIN2+ were reported to HPV-IMPACT during 2015-2017, among which, approximately 29% had IHC testing (n=1,343). Compared to cases with Pap results of atypical squamous cells of unknown significance (ASCUS), cases with a normal Pap result had higher odds of IHC testing (OR 1.42, 95% CI 1.07, 1.88, p=0.01) and cases with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions (ASC-H)/high-grade squamous intraepithelial lesions (HSIL) had lower odds of IHC testing (OR 0.54, 95% CI 0.44, 0.65, p-value <0.01). Cases with a Pap result of low-grade squamous intraepithelial lesions (LSIL) or atypical glandular cells of undetermined significance (AGUS)/adenocarcinoma in situ (AIS) were less likely to have IHC testing compared to ASCUS, but these results were not significant.
Discussion: This study supports the possible association between cytology-based cervical cancer screening results and the use of IHC testing as it is used to diagnose the grade of precancerous cervical lesions among women ages 18-39 years participating in HPV-IMPACT.
Table of Contents
Background/Literature Review……………………………………………….......….1
Methods…………………………………………………………………………………..10
Results ……………………………………………………………………………………16
Discussion………………………………………………………………………………..22
References………………………………………………………………………………..27
Tables…………..………………………………………………………………………...35
Figures……………………………………………………………………………………42
Appendix…………………………………………………………………………………44
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The Association Between Papanicolaou Test Results and Immunohistochemistry Test Utilization in the Diagnosis of Cervical Precancers () | 2019-04-24 13:41:13 -0400 |
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