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Human Papillomavirus Testing and Reporting Rates in 2012: Results of a College of American Pathologists National Survey.

The College of American Pathologists (CAP) has used survey questionnaires to assess practice patterns in cervicovaginal cytology since 1994. These surveys have documented the widespread implementation of the first 2 versions of The Bethesda System, reporting rates for various cervical cytology categories and important benchmarking data for quality assurance. (1-5)

Results of the Atypical Squamous Cells of Undetermined Significance (ASCUS) and Low-Grade Squamous Intraepithelial Lesion (LSIL) Triage Study established the role of high-risk HPV (HR-HPV) testing as a cost-effective triage strategy for atypical squamous lesions and led to development of the 2001 American Society for Colposcopy and Cervical Pathology (ASCCP) management guidelines. (6) The rapid adoption of HPV testing by many cytology laboratories during the next few years prompted the development and distribution of the 2003 CAP Supplemental Questionnaire to assess practice patterns in HPV testing. (5) At that time, the prevalence of HPV in adolescent and young women and in postmenopausal women was not well established. Based on additional studies, the negative predictive value of HPV testing in conjunction with a negative Papanicolaou (Pap) test result in women aged 30 years and older became available, leading to the publication of "interim guidance" in 2004. (7) This was followed by age-defined indications of HPV testing in special populations, especially adolescents and postmenopausal women, as noted in the 2006 update of ASCCP management guidelines. (8) The last CAP survey regarding 2006 practices for HPV testing and reporting rates was distributed in 2007 and published in 2008. The most recent update of the cervical cancer screening guideline and ASCCP management guidelines was in 2011 and 2012, (9, 10) following additional information on performance of HPV type-specific testing (genotyping) and results from a large clinical practice database. (11) The CAP survey questionnaires distributed in 20035 and 200712 attempted to capture the evolving practice patterns related to the updated management strategies. The specific goal of the 2013 CAP HPV Supplemental Questionnaire was to evaluate the 2012 laboratory practice data from laboratories incorporating HPV testing with the Pap test, to compare it to preceding survey results, and to identify trends in HPV testing.

MATERIALS AND METHODS

Data Collection

In 2013, the HPV practice supplemental questionnaire was mailed to 1771 laboratories enrolled in the CAP Human Papillomavirus for Cytology Program (CHPV), and the CAP Gynecologic Cytology Proficiency Testing Program in 2013. Not every laboratory responded to every question.

Laboratories were asked for their HPV testing location, methods of testing, testing personnel, monthly test volumes, whether they provided low-risk HPV (LR-HPV) testing, and percentage of positive HR-HPV results for the interpretive categories of ASC-US, ASC cannot exclude high-grade squamous intraepithelial lesion (ASC-H), atypical glandular cells (AGC), and if testing was as a screening test in conjunction with the Pap test in women aged 30 years and older ("cotesting"). In addition, a question was asked regarding indications for HPV testing. Possible responses included reflex testing for ASC-US, ASC-H, LSIL, high-grade squamous intraepithelial lesion (HSIL), and AGC; adjunct to a Pap test for women 30 years and older (contest); and HR-HPV test performed whenever requested by a provider (nonreflex requested). Some questions regarding geno typing were also provided. The respondents were asked to base all answers on actual clinical practice from 2012.

Percentile rate tables were constructed for appropriate categories. Because several reporting rate distributions were not Gaussian, percentile reporting rates (frequency reporting rates) were presented instead of means and standard deviations. Reporting rates that were unclear or appeared to represent impossible values were deleted. Reporting rates were compared with site of HPV testing, method used, and test volume to validate the reporting rates that were incongruously high in the presence of low Pap test volume. Likewise, those laboratories reporting reflex testing without reporting HPV volumes were verified with the site of testing, method used (collection vial), and Pap volume.

The reported rates of ASC-US testing were compared with data received in 2006 by using a [chi square] test. Statistical analyses for contingency tables were performed using [chi square] tests. Two-sided t tests were used to test associations with the monthly HPV volume. A level of .05 was used for statistical significance. All statistical analyses were performed by using SAS Version 9.1 (SAS Institute Inc, Cary, North Carolina).

RESULTS

Of the 1771 laboratories receiving the questionnaire, 1022 laboratories responded, representing a 57.7% response rate. This response rate is increased compared to the 2006 supplemental questionnaire (42%, 679 of 1621).

Compared to 2006 survey data, (12) the 2012 survey data show a significant decrease in the percentage of laboratories referring HPV testing to outside laboratories (44% [447 of 1022] in 2012 versus 73% [445 of 612] in 2006, P < .001). Conversely, there was an increase in the percentage of laboratories performing HPV testing in another department within their own institution (42% [425 of 1022] in 2012 versus 18% [112 of 612] in 2006, P < .001). The 2012 data also demonstrated an increase in the laboratories performing HPV testing in cytology (15% [150 of 1022] in 2012 versus 9% [55 of 612] in 2006, P < .001) (Table 1). The results from the 2012 survey are significantly different from those identified in 2003 (Table 1).

Of the laboratories that performed HPV testing in-house, 556 responded to the question about the personnel performing the HPV test. The HPV test was performed by 75% (417 of 556) of medical technologists, 24.1% (134 of 556) of cytotechnologists, and 14.2% (79 of 556) of "other" laboratory personnel.

In terms of HR-HPV test volume, 440 of 496 laboratories (88.7%) responded to this question. The mean and median volumes in 2012 were 3355 and 2284, respectively. Sixty-three of 496 laboratories (12.7%) offered LR-HPV testing, significantly fewer than the 45% of laboratories (284 of 632) offering LR-HPV testing in 2006 (P < .001) (Table 2). Thirty-four percent of all laboratories offered type-specific HPV testing (Table 2). There are no comparative data available from the 2006 supplemental questionnaire regarding type-specific HPV testing. (12)

The 2013 survey participants cited a variety of indications for HPV testing, such as clinician requests for HPV testing (nonreflex test requested anytime), as a cotesting with cytology for women aged 30 years and older, and reflex testing (defined as an automatic HR-HPV testing based on a specific interpretation) (Table 3). As in 2006, ASC-US reflex testing is still the most common indication for HPV testing (89.6%, 476 of 531). However, there was an increase in testing for the category of women aged 30 years and older when compared to the 2006 survey (Table 3). Similar to the practice in 2006, many laboratories offered reflex testing in some other circumstances including ASC-H, LSIL, AGC, and HSIL in 2012, with a significant increase in the AGC category.

The most common HR-HPV testing method is Hybrid Capture 2 (Qiagen, Gaithersburg, Maryland) (42.4%, 239 of 564), which was most commonly performed on specimens collected in ThinPrep preservative (Hologic, Bedford, Massachusetts), followed by Digene Standard Transport Medium (Qiagen) and SurePath fixative (Becton, Dickinson and Company, Franklin Lakes, New Jersey) (Table 4). These results are similar to those seen in the 2006 supplemental questionnaire. From the response frequency it appears most laboratories that offer analysis of separate Digene Standard Transport Medium also offer other liquid-based methods. The laboratories offered Cervista HR-HPV test (Hologic) or the cobas 4800 HPV Test (Roche Molecular Systems, Pleasanton, California) at a rate of 37.2% (210 of 564) and 14.9% (84 of 564), respectively, in 2012. However, these tests were not available in 2006.

The frequency of reporting HPV positivity for ASC-US (median: 38.3%, 110 laboratories); ASC-US in women aged 30 years and older (median: 30.7%, 43 laboratories); ASC-US in women younger than 30 years (median: 51.3%, 32 laboratories); ASC-H (median: 53.8%, 103 laboratories); negative for intraepithelial lesion or malignancy, cotested in women aged 30 years and older (median: 6.5%, 81 laboratories); AGC (median: 13.2%, 90 laboratories); and LSIL in postmenopausal women (median: 20.0%, 41 laboratories) are summarized in Table 5. The percentile distributions from 2012 were compared to those from 2006 (Table 6) and the comparison demonstrates that the cotesting positive rate in 2012 (median: 6.5%, 81 laboratories) is statistically greater than that in 2006 (median: 4.0%, 29 laboratories; P = .02). The HPV positive rates for ASC-US and ASC-H in 2012 are similar to those in 2006. Although the HPV positive rate for AGC in 2012 (median: 13.2%, 90 laboratories) is greater than that in 2006 (median: 2.0%, 57 laboratories), no statistical significance was detected (Table 6).

As shown in Table 7, most laboratories use CAP's CHPV as the proficiency test for HPV analysis. Of 524 responding laboratories, 214 (40.8%) performed HPV 16/18 genotype testing for women with HR-HPV-positive and cytology-negative cotest results. HPV 16/18 genotype testing was performed for women younger than 30 years with HR-HPV-positive and cytology-negative cotest results and for women with HR-HPV-positive and ASC-US cytology results in 35.3% (183 of 518) and 37.3% (194 of 520) of responding laboratories, respectively (Table 8).

Human papillomavirus genotype testing was performed by the in-house cytology laboratory in 22.9% (43 of 188) of cases, within the institution but not in the cytology laboratory in 65.4% (123 of 188), and by a reference laboratory in 11.7% (22 of 188). For laboratories offering HPV genotype testing, the Cervista HPV 16/18 test (Hologic) is the most commonly used method (49.2%, 88 of 179), followed by cobas HPV test (Roche Molecular Systems) (27.4%, 49 of 179) (Table 9).

COMMENT

Because the ASCUS/LSIL Triage Study showed that HPV testing was a cost-effective method of triage for Pap tests with an ASC-US result, HR-HPV testing was incorporated into the 2001 ASCCP Consensus Guideline as a preferred method for the triage of women with ASC-US. (6) Since the most recent CAP HPV testing survey in 2006, (12) management guidelines regarding HPV testing have changed. (8, 10) From Kaiser Permanente's study, (11) a Pap test, combined with a concurrent HR-HPV test for women aged 30 years and older, was recommended as a preferred screening method by the recent consensus guidelines. (9) The very high negative predictive value for high-grade cervical disease when the patient has both a negative Pap and a negative HR-HPV test result allows for safe lengthening of the interval between screenings. (9-11)

The data from this survey illustrate the current trend of laboratory practice in HPV testing. The questionnaire requesting a summary of 2012 HPV testing data was distributed to all participating laboratories in the CAP PAP and CHPV programs in 2013. The data were generated from a broad spectrum of practices encompassing hospital laboratories (the largest segment), independent and government laboratories, academic settings, office and group practices, and the Department of Defense and Veterans' hospitals. The 2012 data were compared to the previous 2006 survey. (12)

Compared to 2003 and 2006 survey data, (5, 12) the 2012 survey data showed that significantly more laboratories prefer in-house HPV testing. Having testing performed at the same institution may make issuing an integrated Pap test-HPV test report easier.

Testing for LR-HPV has been shown to have no predictive value for cervical cancer precursors. The percentage of laboratories offering the LR-HPV test is significantly reduced compared with the percentage in 2006, but approximately 13% of laboratories continue to offer LR-HPV testing. This continued availability is probably due to financial considerations and ignorance regarding the lack of relationship between LR-HPV infection and cervical neoplasia. (13) Other national surveys have reported LR-HPV testing and other nonrecommended HPV testing practices by US health care providers, which leads to unnecessary patient follow-up and increased costs without clinical benefit. (14) In the 2012 survey data, type-specific HPV testing is available in approximately half of reporting laboratories, suggesting greater awareness of the importance of HPV types (especially HPV 16 and HPV 18) in clinical management, as recommended by current 2012 management consensus guidelines. (10)

As in the 2006 survey, ASC-US reflex HR-HPV testing is still the most common scenario reported by respondents in 2012. However, the rate of nonreflex testing requested anytime or as a cotesting with cytology for women aged 30 years and older significantly increased in 2012 compared to 2006, suggesting that more practitioners are adopting the current management guidelines that recommend Pap and HPV cotesting as the preferred primary screening method. Approximately 20% to 30% of laboratories offered reflex HPV testing for women with HSIL, LSIL, and AGC Pap test results, and 43% of laboratories offered reflex HPV testing for women with ASC-H, although reflex HPV testing is not recommended for these abnormal categories in the consensus guidelines for the management of women with abnormal cervical screening tests. (8, 10)

High-risk HPV median positive rate for cotests was 6.5% in 2012, significantly greater than that (4.0%) in 2006. The reason for the increase is undetermined, although we think differences in the testing population are likely to be the main cause. In recent years the use of cotesting for women aged 30 years and older has been significantly expanded as compared to the situation in 2006. Relatively fewer laboratories (29) responded to this question in the 2006 survey, compared to 81 laboratories in the current study. The rate of 6.5% seen now may reflect a better sampling of the national situation, changes in the demographics of women being screened, or some combination of both. The median HR-HPV positive rates for ASC-US and ASC-H in 2012 are 38.3% and 53.8% (Table 5), respectively, similar to those in 2006. High-risk HPV positive rates for ASC-US in the literature are variable, mainly depending on the age of the populations. This survey shows that the median HR-HPV positive rate is 51.3% in ASC-US for women younger than 30 years, which is significantly higher than the rate of 30.7% in ASC-US for women aged 30 years and older, demonstrating the importance of considering age when interpreting HR-HPV testing results for women with ASC-US Pap test results.

Although in the 2012 survey the most common HR-HPV testing method is still Qiagen HC2, the laboratories offering either Cervista HR-HPV test or Roche cobas HPV test have increased, and the percentage of laboratories offering the Cervista HR HPV test approximates the percentage of laboratories offering the HC2 test.

In summary, most laboratories experienced increased volumes of HR-HPV testing with a shift toward in-house HR-HPV testing including HPV genotyping. Qiagen HC2 and Cervista HR HPV test continue to be the most common tests with an increasing volume of the Roche cobas 4800 HPV test. Most HPV tests are requested for reflex testing, but HPV-Pap cotests are also increasing. These data provide an update into persisting and newer trends in HPV testing practices.

The study was supported by the College of American Pathologists (CAP), but conceptualized by members of the CAP Cytopathology Committee.

References

(1.) Davey DD, Naryshkin S, Nielsen ML, Kline TS. Atypical squamous cells of undetermined significance: interlaboratory comparison and quality assurance monitors. Diagn Cytopathol. 1994; 11(4):390-396.

(2.) Davey Dd, Nielsen ML, Naryshkin S, Robb JA, Cohen T, Kline TS. Atypical squamous cells of undetermined significance: current laboratory practices of participants in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology. Arch Pathol Lab Med. 1996; 120(5):440-444.

(3.) Davey DD, Nielsen ML, Rosenstock W, Kline TS. Terminology and specimen adequacy in cervicovaginal cytology: the College of American Pathologists Interlaboratory Comparison Program experience. Arch Pathol Lab Med. 1992; 116(9):903-907.

(4.) Davey DD, Woodhouse S, Styer P, Stastny J, Mody D. Atypical epithelial cells and specimen adequacy: current laboratory practices of participants in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology. Arch Pathol Lab Med. 2000; 124(2):203-211.

(5.) Davey DD, Neal MH, Wilbur DC, Colgan TJ, Styer PE, Mody DR. Bethesda 2001 implementation and reporting rates: 2003 practices of participants in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology. Arch Pathol Lab Med. 2004; 128(11):1224-1229.

(6.) Wright TC, Cox JT, Massad LS, Twiggs LB, Wilkinson EJ. 2001 consensus guidelines for the management of women with cervical cytological abnormalities. IAMA. 2002; 287(16):2120-2129.

(7.) Wright TC, Schiffman M, Solomon D, et al. Interim guidance for the use of human papillomavirus DNA testing as an adjunct to cervical cytology for screening. Obstet Gynecol. 2004; 103(2):304-309.

(8.) Wright TC Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D. 2006 consensus guidelines for the management of women with abnormal cervical screening tests. J Low Genit Tract Dis. 2007; 11(4): 201-222.

(9.) Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. J Low Genit Tract Dis. 2012; 16(3):175-204.

(10.) Massad LS, Einstein MH, Huh WK, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol. 2013; 121(4):829-846.

(11.) Katki HA, Kinney WK, Fetterman B, et al. Cervical cancer risk for women undergoing concurrent testing for human papillomavirus and cervical cytology: a population-based study in routine clinical practice. Lancet Oncol. 2011; 12(7): 663-672.

(12.) MoriartyAT, Schwartz MR, Eversole G, et al. Human papillomavirus testing and reporting rates: practices of participants in the College of American Pathologists Interlaboratory Comparison Program in Gynecologic Cytology in 2006. Arch Pathol Lab Med. 2008; 132(8):1290-1294.

(13.) Moriarty AT. A rock and a hard place: HPV testing and financial gain. Diagn Cytopathol. 2007; 35(8):463-464.

(14.) Lee JW, Berkowitz Z, Saraiya M. Low-risk human papillomavirus testing and other nonrecommended human papillomavirus testing practices among US health care providers. Obstet Gynecol. 2011; 118(1):4-13.

Chengquan Zhao, MD; Ann T. Moriarty, MD; Mohiedean Ghofrani, MD; Mujtaba Husain, MD; Rosemary H. Tambouret, MD; Rodolfo Laucirica, MD; Alice Laser, MD; Andrew Fischer, MD; Idris T. Ocal, MD; Rhona J. Souers, MS; Donna K. Russell, MS, CT(ASCP); Fang Fan, MD, PhD; Barbara A. Crothers, DO

Accepted for publication September 10, 2014.

Published as an Early Online Release December 1, 2014.

From the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Zhao); the Department of Esoteric Testing, AmeriPath Indiana, Indianapolis (Dr Moriarty); the Department of Pathology, PeaceHealth Laboratories, Vancouver, Washington (Dr Ghofrani); Clinical Sciences, University of Central Florida, Orlando (Dr Husain); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Tambouret); the Department of Pathology, Baylor College of Medicine, Houston, Texas (Dr Laucirica); the Department of Pathology, North Shore-LIJ Health System, New Hyde Park, New York (Dr Laser); the Department of Pathology, University of Massachusetts Medical School, Worcester (Dr Fischer); the Department of Pathology, Mayo Clinic, Scottsdale, Arizona (Dr Ocal); Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, University of Rochester Medical Center, Rochester, New York (Ms Russell); the Department of Pathology, University of Kansas Medical Center, Kansas City (Dr Fan); and the Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland (Dr Crothers).

The authors have no relevant financial interest in the products or companies described in this article.

Presented as a platform presentation at the 2014 Annual Meeting of the United States and Canadian Academy of Pathology; March 3, 2014; San Diego, California.

Reprints: Chengquan Zhao, MD, Department of Pathology, University of Pittsburgh Medical Center, 300 Halket St, Pittsburgh, PA 15213 (e-mail: zhaoc@upmc.edu).
Table 1. Site of Human Papillomavirus Testing (a), (b)

Site                   2012 No. (%)   2006 No. (%)   2003 No. (%)
                        (n = 1022)     (n = 612)      (n = 595)

Cytology laboratory     150 (14.7)      55 (8.9)       35 (5.9)
  in-house
Another department      425 (41.6)     112 (18.3)     97 (16.3)
  in-house
Reference laboratory    447 (43.7)     445 (72.7)     463 (77.8)

(a) The site frequency differs between the 3 years (P < .001).

(b) There is a statistically significant decreasing trend in testing
at reference laboratories (Cochran Armitage test; P < .001).

Table 2. Types of Human Papillomavirus (HPV) Testing and Test Volume
in 2012 (n = 496)

Types of HPV Test   No. (% Performed)    Mean    10th Pctl

High-risk HPV          440 (88.7)       3355.4      330
Low-risk HPV            63 (12.7)       1429.4      10
Type-specific HPV      169 (34.1)       480.1       13

Types of HPV Test   25th Pctl   50th Pctl   75th Pctl   90th Pctl

High-risk HPV         1051        2284        5104        8713
Low-risk HPV           120         743        1903        3185
Type-specific HPV      50          200         860        2665

Abbreviation: Pctl, percentile.

Table 3. Indications for High-Risk Human Papillomavirus Testing

Type of Options         2012 No. (%)   2006 No. (%)   P Value
(Multiple Responses       (n = 531)     (n = 560)
Allowed)

ASC-US reflex            476 (89.6)     503 (89.8)      .92
Nonreflex test           404 (76.1)     332 (59.3)    < .001
requested anytime
Cotest for women aged    320 (60.3)     137 (24.5)    < .001
30 y and older
ASC-H reflex             227 (42.7)     269 (48.0)      .08
LSIL reflex              158 (29.8)     156 (27.9)      .49
AGC reflex               145 (27.3)     111 (19.8)     .003
HSIL reflex              123 (23.2)     121 (21.6)      .54

Abbreviations: AGC, atypical glandular cells; ASC-H, atypical squamous
cells, cannot exclude high-grade squamous intraepithelial lesion;
ASC-US, atypical squamous cells of undetermined significance; HSIL,
high-grade squamous intraepithelial lesion; LSIL, low-grade
intraepithelial lesion.

Table 4. Testing Methods Used for High-Risk Human Papillomavirus
(n = 564)

Methods (a)                          No.   Percentage

Qiagen HC2-all types of media (b)    239      42.4
  Qiagen HC2-ThinPrep                204      36.2
  Qiagen HC2-Standard Transport
    Medium                           151      26.8
  Qiagen HC2-SurePath                97       17.2
Hologic Cervista                     210      37.2
Roche cobas                          84       14.9
Hologic Gen-Probe APTIMA             31       5.5
Others                               22       3.9
Polymerase chain reaction            17       3.0
Laboratory-developed test            16       2.8
Access Genetics                      15       2.7
Roche AMPLICOR                        9       1.6
Roche LINEAR ARRAY                    7       1.2
In situ hybridization                 6       1.1

(a) HC2: Qiagen, Gaithersburg, Maryland;ThinPrep: Hologic, Bedford,
Massachusetts;SurePath: Becton, Dickinson and Company, Franklin
Lakes, New Jersey;Roche methods: Roche, Pleasanton, California;
Access Genetics: Minneapolis, Minnesota.

(b) Multiple responses were allowed. When the 3 HC2 media types are
combined, the overall usage rate is 42% (239 of 564).

Table 5. High-Risk Human Papillomavirus (HPV) Positive Rate
Percentage

Categories                        N    Mean    10th   25th

Total HPV tested volume          463   22.60   10.0   13.8
reported positive
ASC-US in women aged 30 y         43   31.91   19.8   25.0
and older (CHPV)
ASC-US in women younger than      32   47.73   25.9   42.1
30 y (CHPV)
ASC-US (CAP PAP)                 110   37.05   11.8   26.4
ASC-H                            103   39.87    0.0    1.0
NILM Pap test cotest in women     81   10.91    2.1    4.4
older than 30 y
AGC                               90   16.47    0.0    0.0
LSIL in postmenopausal women      41   31.15    0.0    0.8

Categories                       50th   75th   90th

Total HPV tested volume          20.0   28.4   38.5
reported positive
ASC-US in women aged 30 y        30.7   38.3   53.3
and older (CHPV)
ASC-US in women younger than     51.3   56.5   63.2
30 y (CHPV)
ASC-US (CAP PAP)                 38.3   47.8   54.7
ASC-H                            53.8   68.1   79.0
NILM Pap test cotest in women     6.5   11.0   22.5
older than 30 y
AGC                              13.2   27.0   39.3
LSIL in postmenopausal women     20.0   64.1   76.8

Abbreviations: AGC, atypical glandular cells; ASC-H, atypical squamous
cells, cannot exclude high-grade squamous intraepithelial lesion;
ASC-US, atypical squamous cells of undetermined significance; CAP,
College of American Pathologists; CAP PAP, CAP Interlaboratory
Comparison Program in Cervicovaginal Cytology; CHPV, CAP Human
Papillomavirus for Cytology Program; LSIL, low-grade intraepithelial
lesion; NILM, negative for intraepithelial lesion or malignancy.

Table 6. Comparison of High-Risk Human Papillomavirus Positive Rate
Between 2006 and 2012

                        10th   50th   90th        P
Category           N    Pctl   Pctl   Pctl    Value (a)

ASC-US positive                                  .52
  2006            157   15.2   36.6   53.2
  2012            110   11.8   38.3   54.7

ASC-H positive                                   .96
  2006             73    0.0   50.0   89.0
  2012            103    0.0   53.8   79.0

Cotest positive                                  .02
  2006            29     0.0    4.0    24.5
  2012            81     2.1    6.5    22.5

AGC positive                                     .51
  2006            57     0.0    2.0    72.3
  2012            90     0.0   13.2    39.3

Abbreviations: AGC, atypical glandular cells; ASC-H, atypical squa-
mous cells, cannot exclude high-grade squamous intraepithelial
lesion; ASC-US, atypical squamous cells of undetermined significance;
Pctl, percentile.

(a) Kruskal-Wallis test.

Table 7. Human Papillomavirus Proficiency Testing

Types                            No.   Percentage

CHPV                             496      93.1
New York State PT                 12       2.3
None                              11       2.1
Other                              7       1.3
Interlaboratory comparison PT      6       1.1
CAP Virology                       1       0.2

Abbreviations: CAP, College of American Pathologists; CHPV, CAP
Human Papillomavirus for Cytology Program; PT, proficiency test.

Table 8. Human Papillomavirus (HPV) 16/18
Genotyping in 2012

Categories                     Total          No.   Performed
                         Response Performed         Percentage
                                No.

For women with HR-              524           214      40.8
  HPV positive and Pap
  negative cotesting
  result

For women younger than          518           183      35.3
  30 y with HR-HPV
  positive and Pap
  negative cotesting
  result

For women with HR-              520           194      37.3
  HPV-positive and
  ASC-US Pap result

Abbreviations: ASC-US, atypical squamous cells of undetermined
significance; HR-HPV, high-risk HPV; Pap, Papanicolaou.

Table 9. Human Papillomavirus (HPV) 16/18
Genotyping Methods in 2012

Methods                           No.   Percentage

Hologic Cervista HPV 16/18 (a)     88      49.2
Roche cobas (b)                    49      27.4
PCR (other than Roche)             18      10.1
Others                             24      13.4
Total                             179     100

Abbreviation: PCR, polymerase chain reaction.

(a) Bedford, Massachusetts.

(b) Pleasanton, California.
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Title Annotation:CAP Laboratory Improvement Programs
Author:Zhao, Chengquan; Moriarty, Ann T.; Ghofrani, Mohiedean; Husain, Mujtaba; Tambouret, Rosemary H.; Lau
Publication:Archives of Pathology & Laboratory Medicine
Date:Jun 1, 2015
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