LSIL biopsies after HSIL smears - Correlation with high-risk HPV and greater risk of HSIL on follow-up

Can the risk associated with a high-grade cervical smear be disregarded whe n followed by a low-grade biopsy? We examined the distribution of human pap illomavirus (HPV) types in such cases to see whether they segregated prefer entially with low-risk or high-risk viruses and compared the distribution w ith that reported in the literature for women with high-grade squamous intr aepithelial lesions (HSILs) and low-grade squamous intraepithelial lesions (LSILs). We identified 48 cases of HSIL smears with corresponding LSIL biop sy specimens. Biopsy specimens were tested and typed for HPV by polymerase chain reaction amplification with consensus primers followed by restriction fragment length polymorphism analysis, and HPVs were scored as low-risk or high-risk types. Thirty-seven cases scored positive for HPV DNA: 2 for low -risk HPV types, 17 for high-risk types, and 18 for types of unknown oncoge nicity. The prevalence of high-risk HPV was significantly higher than that of low-risk HPV. There was a higher rate of high-risk HPV than that seen in historic unselected LSIL cases. Cases of HSIL cytology/LSIL histology repr esent a group distinct from unselected LSILs by virtue of their higher prev alence of high-risk HPV types and, therefore, warrant closer clinical follo w-up.