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83342<br />

with HPV effect -High-grade squamous intraepithelial lesion (HSIL), which includes moderate squamous<br />

dysplasia (CINII), severe squamous dysplasia (CINIII), and squamous carcinoma in situ (CINIII)<br />

-Atypical glandular cells: Patients with this diagnosis are at increased risk for a clinically significant<br />

lesion, including adenocarcinomas in situ, high-grade squamous intraepithelial lesion, invasive cervical<br />

carcinoma, or endometrial carcinoma, and should have appropriate clinical follow-up that may include<br />

gynecologic examination, colposcopy, or biopsy. HPV: A positive HPV test result indicates the presence<br />

of 1 or more of the high-risk HPV types (16, 18, 31, 33, 35, 39, 45, 51, 52, 58, 59, or 68).<br />

Reference Values:<br />

ThinPrep PAP <strong>Test</strong> Screen:<br />

Satisfactory for evaluation. Negative for intraepithelial lesion or malignancy.<br />

High Risk HPV DNA Detection:<br />

Negative for types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68<br />

Clinical References: 1. Lorincz AT, Richart RM: Human papillomavirus DNA testing as an adjunct<br />

to cytology in cervical screening programs. Arch Pathol Lab Med 2003 August;127(8):959-968 2. Wright<br />

TC, Jr, Schiffman M: Adding a test for human papillomavirus DNA to cervical-cancer screening. N Engl<br />

J Med 2003 February 6;348(6):489-490 3. Soloman D, Davey D, Kurman R, et al: The 2001 Bethesda<br />

System: terminology for reporting results of cervical cytology. JAMA 2002 April;287(16):2114-2119 4.<br />

Sherman ME, Lorincz A, Scott DR, et al: Baseline cytology, human papillomavirus testing, and risk for<br />

cervical neoplasia: a 10-year cohort analysis. J Nat Cancer Inst 2003 January;95(1):46-52<br />

ThinPrep Screen with Human Papillomavirus (HPV) Reflex<br />

Clinical Information: Squamous cell carcinoma of the cervix is believed to develop in progressive<br />

stages from normal through precancerous (dysplastic) stages, to carcinoma in situ, and eventually invasive<br />

carcinoma. This sequence is felt to develop over a matter of years in most patients. Follow up of the<br />

cervical Pap abnormality "atypical squamous cells of undetermined significance (ASCUS)" is costly and<br />

frustrating to patients and clinicians because a large percentage of these patients have normal colposcopic<br />

and biopsy findings. Yet, a significant percentage (10% to 15%) will have an underlying high grade<br />

squamous intraepithelial lesion (HSIL). The majority (>99%) of cervical epithelial neoplasms are the<br />

result of human papillomavirus (HPV) infection. Some HPV types ("low-risk", types 6 and 11) are<br />

associated with low-grade squamous intraepithelial lesions (LSIL) that are benign and do not progress to<br />

carcinoma. "High-risk" HPV types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68) can result in<br />

both LSIL and HSIL, as well as invasive carcinomas. Patients with HSIL have a greater risk for<br />

progression to carcinoma. In the setting of an ASCUS Pap result, the presence of high risk HPV types in<br />

cervical specimens, identifies a subgroup of patients with a greater likelihood of having a HSIL.<br />

Useful For: Triage of equivocal Pap abnormalities (atypical squamous cells of undetermined<br />

significance [ASCUS])<br />

Interpretation: The Pap report in an estimate of the nature of the abnormality using the Bethesda<br />

nomenclature Specimen adequacy is characterized as: -Satisfactory for evaluation (with quality indicators<br />

if applicable) -Unsatisfactory for evaluation, further subdivided as follows: - Specimen processed and<br />

examined but unsatisfactory for evaluation of epithelial abnormality because of scanty cellularity,<br />

obscuring blood or inflammation, etc. - Specimen rejected because of a broken slide, unlabeled specimen,<br />

etc. The diagnostic interpretation may include: -Negative for intraepithelial lesion or malignancy (NIL)<br />

-Atypical squamous cells of undetermined significance (ASCUS) characterized further as either: -Atypical<br />

squamous cells of undetermined significance -Atypical squamous cells, cannot exclude high-grade<br />

intraepithelial lesion -Low-grade squamous intraepithelial lesion (LSIL), which includes mild squamous<br />

dysplasia (cervical intraepithelial neoplasia I [CINI]) and koilocytotic changes consistent with human<br />

papillomavirus (HPV) effect -High-grade squamous intraepithelial lesion (HSIL), which includes<br />

moderate squamous dysplasia (CINII), severe squamous dysplasia (CINIII), and squamous carcinoma in<br />

situ (CINIII) -Atypical glandular cells: Patients with this diagnosis are at increased risk for a clinically<br />

significant lesion, including adenocarcinoma in situ, high-grade squamous intraepithelial lesion, invasive<br />

cervical carcinoma, or endometrial carcinoma and should have appropriate clinical follow-up that may<br />

include gynecologic examination, colposcopy, or biopsy. HPV: A positive test result indicates the<br />

Current as of January 4, 2013 7:15 pm CST 800-533-1710 or 507-266-5700 or <strong>Mayo</strong><strong>Medical</strong><strong>Laboratories</strong>.com Page 1730

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