Atypical squamous cells: The case for HPV testing

The office staff. Whenever a new test or procedure is introduced, it is of primary importance that the office staff responsible for completing critical information on the requisition form is adequately trained. This involves knowing when and how to order the test and how to complete insurance information and clinical history on the Pap requisition—including the correct International Classification of Diseases, Ninth Revision code—to ensure that the HPV test is covered by the patient’s insurer.

Clinicians must understand the usually benign nature of HPV infection. Reporting a positive HPV test in a manner that is not unduly concerning requires reassuring and nonjudgmental communication of the results based on a broad understanding of the usually low-risk natural history of the virus, yet fosters responsible follow-up.

Why all HPV-positive ASC-US requires diligent follow-up

The recently released ASCCP guidelines recognize HPV testing as an option in the management of ASC results, including:

• initial management of ASC-US,
• postcolposcopy management of ASC-H or HPV-positive ASC Pap tests found to be normal or to have CIN 1, and
• posttreatment follow-up.

For each indication, the HPV test identifies women most likely to have CIN (HPV-positive) and those likely to have benign processes not related to HPV (HPV-negative).

New longitudinal data verify that women with HPV-positive ASC-US continue at risk for detection of CIN 2,3 (about 12% overall), whether the original colposcopic finding was normal or CIN 1.⁸ Therefore, they need continued diligent follow-up.

Dr. Cox serves on the Speaker’s Bureaus of Cytyc Corporation and Digene Corporation.