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Dermatopathology Cytologic Abnormalities (ASC-US/LSIL) with High Resolution Anoscopy (HRA) and Biopsy

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Dermatopathology Cytologic Abnormalities (ASC-US/LSIL) with High Resolution Anoscopy (HRA) and Biopsy 110A ANNUAL MEETING ABSTRACTS screening guidelines for anal cancer. Here, we describe our anal cytology experience, hysterectomy. The significantly increased detection rate of VAINs in hrHPV-positive with regards to the patient population, the distribution of cytologic results, hrHPV (high group suggests vaginal cytology and HPV co-testing is preferred for follow-up of risk human papillomavirus) detection rates and the histologic outcomes. women with invasive cervical carcinoma after hysterectomy. Design: A database search was conducted from January 2007 to June 2012 for anal cytologic tests (ThinPrep). Clinical information, the results of concurrent hrHPV testing 451 Non-16/18 HR-HPV Genotypes Are Superior to HPV 16/18 for (Hybrid Capture 2) if available, and histologic follow-up within the next 18 months, if Predicting High-Grade Intraepithelial Lesions in LEEP Resections any, were compiled. Also, the development of invasive squamous cell carcinoma during H Zhou, D Mody, M Schwartz, Y Ge. Methodist Hospital, Houston, TX. the study period was recorded. Statistical analysis was performed using chi-square test Background: HPV 16 and 18 are responsible for the majority of cases of high-grade and Fisher’s exact test and a p value of < 0.05 was considered as statistically significant. squamous intraepithelial lesions (HSIL) and cervical cancer. While HPV 16/18 have Results: 443 patients had anal cytologic tests – average age 44.4 years (range 17-80 been extensively studied, more than a dozen non-16/18 high risk HPV (HR-HPV) years), 74% HIV positive (318 men, 4 women), 26% HIV negative (56 men, 65 women). genotypes have been overshadowed by the two leading HPV types and have received The distribution of cytologic diagnoses is depicted below. much less attention. With the current vaccines directed against HPV 16/18, non-16/18 HR-HPV genotypes are expected to play an increasing role in cervical cancer screening and prevention. Therefore, evaluating the predictive value of non-16/18 type HR-HPV is pertinent for early detection and cancer prevention, as well as for future vaccine development. Design: A cohort of 808 SurePath specimens were collected from women who were referred to our institution from 12/2009-4/2011 for abnormal Pap tests. HPV genotypes were determined by DNA microarray against 40 HPV subtypes followed by a confirmatory sequencing assay. Forty-three patients from the cohort had a concurrent or subsequent LEEP procedure. Correlations among HPV genotype, cytologic findings and LEEP findings were analyzed. Results: The HR-HPV infection rate was 81.4% in the 43 patients who underwent a LEEP and 94.4% in patients with HSIL on Pap tests. Cytologic interpretation of HSIL had 88.9% positive predictive value (PPV) for any grade of dysplasia and 83.3% for CIN 2 and above lesions in LEEPs. The PPV of non-16/18 HR-HPV for any grade of dysplasia in LEEPs was 93.3%, which was significantly better than that of HPV 16/18 (65%, p=0.049). For patients with CIN 2 and above lesions in LEEPs, the PPV of non- 16/18 HR-HPV (73.3%) was also better than that of HPV 16/18 alone (58.3%). HPV 31/52/58/39/45 genotypes were commonly detected in women with HSIL in LEEP specimens. Furthermore, all patients with HPV31/52/58 infection documented on Pap Histologic follow-up was available in 173 (39%) patients. High-grade AIN or above was test had HSIL in LEEP (100% positive predictive value). diagnosed in 30.2% ASC-US, 47.6% LSIL, 77.8% HSIL and 72.2% ASC-H/LSIL-H Conclusions: The predictive value of non-16/18 HR-HPV genotypes for HSIL in LEEPs cases. The difference between the detection rates for high-grade AIN or above in the was superior to that of the HPV 16/18 test. The HPV16/18-only test may be not having following groups was not statistically significant – ASC-US vs. LSIL, HSIL vs. ASC-H/ as a high value as perceived, and a negative result may give a false assurance, especially LSIL-H and HIV positive vs. HIV negative patients. 76% ASC-US cases were hrHPV in high risk populations. In addition to HPV 16/18, an expanded test panel of HR-HPV positive, of those that were tested. Invasive squamous cell carcinoma was diagnosed in genotypes to include some of the non-16/18 genotypes with high PPV (such as HPV 6 patients – 5 on immediate follow-up and one 33 months following an initial biopsy 31/52/58) may be warranted. At the present time, testing with a cocktail of HR-HPV with AIN2, 3 were HIV positive, cytologic diagnoses included NILM (1), LSIL (2), types appears to offer a better predictive value for HSIL than using an HPV 16/18 test. LSIL-H (2) and HSIL (1). Conclusions: Our study reveals a high rate of detection of high grade AIN following an abnormal cytology diagnosis and supports the management of patients with lesser Dermatopathology cytologic abnormalities (ASC-US/LSIL) with high resolution anoscopy (HRA) and biopsy. Given the high hrHPV positivity rate in the ASC-US group, hrHPV testing may 452 The Impact on Final Breslow Thickness and Sentinel Lymph not play a significant role in the triage of these patients to HRA. Node Status with Initial Biopsies of Cutaneous Melanomas Transected at the Base 450 Vaginal Cytology and HPV Co-Testing Is Preferred for Follow-Up A Agarwal, CA Torres-Cabala, MT Tetzlaff, DL Stockman, V Chu, VG Prieto, JL Curry. of Women with Invasive Cervical Cancer Treated by Hysterectomy Baylor College of Medicine, Houston, TX; University of Texas MD Anderson Cancer C Zhao, Z Li, S Barron, W Hong, A Karunamurthy. University of Pittsburgh Medical Center, Houston, TX. Center, Pittsburgh, PA; Conemaugh Memorial Medical Center, Johnstown, PA. Background: The histologic evaluation of primary tumor characteristics (Breslow Background: New cervical cancer screening guidelines indicate that women who have thickness (BT), mitotic rate (MR), ulceration) in cutaneous melanoma is critical undergone hysterectomy and no history of cervical intraepithelial neoplasia (CIN) 2+ for staging and classification, prognosis and clinical management decisions. BT is should not be screened for vaginal cancer. Women who have had a hysterectomy for a strong and consistent histologic parameter of sentinel lymph node (SLN) status. invasive cervical cancer/CIN2+ may be at an increased risk of vaginal cancer, but data Melanomas that are superficially sampled with tumor cells present at the deep tissue are very limited. edge may underestimate true BT, pose a risk for positive SLNB, and provide inaccurate Design: A computer-based search of CoPath files was carried out to retrieve cases prognostic information. We report the impact of positive deep margins on initial biopsies with invasive cervical carcinoma treated by hysterectomy with histopathologic and/ of cutaneous melanoma with respect to final BT on wide local excision (WLE) and or cytologic follow-up results during a study period of 10 years. Surgical pathology outcome of SLNB. reports, follow-up hrHPV testing, cytologic, and histopathologic results were recorded. Design: An eighteen month retrospective review was performed in patients diagnosed Results: 147 patients with invasive cervical carcinoma [76 squamous cell carcinoma with primary cutaneous melanoma who undergone WLE and SLNB. Patients were (SqCC), 60 adenocarcinoma (ADC) and 11 adenosquamous carcinoma] treated by categorized into four groups according to status of deep margin on initial biopsy hysterectomy and follow-up results were identified. The average age of these patients and outcome of SLNB. G1=absence of positive deep margin and negative SLNB, was 43 years (range: 29-72) at the time of diagnosis. The average follow-up period G2=absence of positive deep margin and positive SLNB, G3=positive deep margin was 43.3 months (range: 3-139). Two cases (1.4%) of recurrent/residual SqCC were and negative SLNB, G4=positive deep margin and positive SLNB. Comparisons detected in vagina/vulva during follow-up, 1 and 11 months after the hysterectomy, between groups were made with Kruskal Wallis test. Statistical significance was respectively. 20 patients (13.6%) developed vaginal intraepithelial neoplasias (VAINs) considered at p <0.05. during follow-up (table 1). The average interval between hysterectomy and initial Results: 171 patients fulfilled the criteria and were distributed into the four categories diagnosis of VAIN2/3/HSIL (8 cases) was 8.6 months (range: 1-24). 47 women had as follows: G1 (70), G2 (31) G3 (51), G4 (19). Groups with positive SLNB (G2 & G4) hrHPV testing during follow-up and 29.7 % (11/47) had at least one positive hrHPV had greater final BT than patients with negative SLNB (G1 & G3) regardless of the testing. Importantly, VIN was detected in 54.5% (6/11) of patients with hrHPV-positive status of deep tissue edge on initial skin biopsy. The final BT in patients in G4 patients result compared to 16.7% (6/36) of patients with negative hrHPV-negative result. was significantly greater compared to the final BT in the other groups. G4 patients also Vaginal cytologic and histologic follow-up results in 147 patients with invasive cervical had greater tumor deposit size in SLNB compared to G2 patients. carcinoma treated by hysterectomy. Table 1 Case# Carcinoma VIN2/3/HSIL VIN1/LSIL Neg/ASC G1 G2 G3 g Histology 34 2 7 9 16 CL median (range) 4 (2-5) 4 (4-5) 4 (2-5) 4 (3-5) Cytology only 113 0 1 3 109 Initial BT mm* (range) 2.4(0.4-17) 3.12(0.54-15) 2.19(0.20-9.7) 2.86(0.57-5.0) Total 147 2 8 12 125 Final BT mm* (range) 2.55(0.44-17) 3.18(0.54-15) 2.60(0.20-9.7) 3.38(1.5-5.0) Legend: VIN: vaginal intraepithelial neoplasia; H/LSIL: high/low grade intraepithelial lesion; Neg: Tumor deposit size (mm)* in NA 1.63(0.1-5.3) NA 2.77(0.1-15) negative; ASC: atypical squamous cells.
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