Human papillomavirus testing in patients with invasive cervical carcinoma: An institutional experience

The 2012 American Cancer Society cervical cancer screening guidelines' preferred method of screening women ages 30 to 65 years is through cytology and human papillomavirus (HPV) co-testing every 5 years. Our objective was to review the performance of HPV testing in invasive cervical carcinoma in view of these recommendations.

The University of Chicago Pathology database was searched for surgical specimens with primary cervical carcinoma diagnosis from January 1, 2005 to March 30, 2013. All cases with HPV and Papanicolaou smear results within 5 years prior to initial diagnosis were selected for analysis. HPV DNA testing was performed on residual liquid-based screening cytology specimens using Digene Hybrid Capture 2 (Qiagen, Gaithersburg, MD).

Seven patients met the inclusion criteria, including 5 cases of cervical squamous cell carcinoma (SCC) and 2 cases of cervical adenocarcinoma. One patient with SCC tested negative twice for high-risk HPV and 4 cases (2 cases of SCC and 2 cases of adenocarcinoma) tested positive for high-risk HPV. The remaining 2 cases of SCC alternatively tested positive and negative for high-risk HPV on different occasions. In 1 case of SCC, testing was initially positive, then negative, and finally positive prior to histologic diagnosis. In the other case of SCC, testing was initially positive, but negative on repeat testing.

Though limited by sample size, our results demonstrate that false-negatives in HPV testing for primary cervical carcinoma can occur. False-negative HPV results have significant repercussions with the newly recommended extended screening intervals, particularly in the setting of negative cytology.