Screening Test Results Associated With Cancer Diagnoses in 287 Women With Cervical Squamous Cell Carcinoma

Context.-The limitations of newer cervical screening tests are still being studied. Objective.-To investigate those limitations, we conducted a retrospective review of 287 cases of cervical squamous cell carcinoma (SCC). Design.-A search through 5 years of records identified 287 women with cervical SCC diagnoses. Clinical history, histopathology, and liquid-based cytology (ThinPrep) and Hybrid Capture 2 (HC2) high-risk human papillomavirus (HPV) results were documented. Polymerase chain reaction HPV tests were performed on SCC tissues with prior negative HC2 results. Results.-Of 287 women, 156 (54.4%) had abnormal cytology results, and 75 (26.1%) had abnormal clinical findings triggering tissue diagnoses of SCC. Among 156 patients with abnormal Papanicolaou (Pap) test results, more-seriously abnormal Pap test results were reported in 142 women (91.1%). Among 31 women with Pap and HC2 HPV cotesting within 1 year of SCC diagnoses, 28 (90%) were Pap(+)/HPV+, 2 (15.5%) were Pap(+)/HPV-, and 1 (3%) was Pap(-)/HPV-. Two of 3 women with negative HC2 results before SCC diagnosis had abnormal Pap results; 1 had negative Pap reports with questionable lesional cells mimicking atrophy. In all 3 cases of SCC with negative HC2 results, HPV-18 was detected; in 2 cases (66%), HPV-16 was also detected. Conclusions.-Although abnormal cytology preceded most SCC diagnoses, about one-third of patients were referred for diagnostic testing because of clinical suspicion alone. Among 31 SCC cases with liquid-based cytology and high-risk HPV cotest results less than 1 year before SCC diagnoses, 2 patients (6.5%) had Pap(+)/HPV- results, and 1 patient (3.2%) had Pap(-)/HPV- results. Polymerase chain reaction detected high-risk HPV DNA in tumor tissues of 3 SCC cases with recent HC2(-) results. (Arch Pathol Lab Med. 2012; 136: 1533-1540; doi: 10.5858/arpa.2011-0609-OA)