The finding of atypical glandular cells (AGC) is important for the possible prevention of endocervical adenocarcinoma (ADCA). This diagnosis group is quite unspecific and includes several cases with reactive conditions as well as dysplastic squamous lesions. The purpose of this study is to determine how reflex HPV analysis may improve the positive predictive value (PPV) of AGC.
During 2014 - 2015, altogether 385 LBC samples (ThinPrep®, Hologic) were diagnosed as AGC. Reflex HPV analysis were performed by the Cobas 4800 platform (Roche Diagnostics). Histological follow-up was available in 206 (54%) cases - 105 (51%) of these containing HR-HPV.
The HPV positive group contains 3 cases of cervical ADCA and 15 cases of adenocarcinoma in situ (AIS) together with 51 cases of high grade squamous intraepithelial lesion (HSIL). The PPV for a lesion to treat was 69/105 (66%). The corresponding figures for the HPV negative group was 3 endometrial carcinomas, 1 metastatic breast carcinoma and 2 HSIL, giving a corresponding PPV of 6/101 (6%). HR-HPV was found in 69/71 cases with cervical lesions to treat (sensitivity 97%).
The results highlight the importance of combined cytology and HPV analysis. HPV defines AGC cases with an exceptionally high PPV for high grade lesion to motivate follow-up.
Wang J, Andrae B, Sundstrom K, Strom P, Ploner A, Elfstrom KM, et al. Risk of invasive cervical cancer after atypical glandular cells in cervical screening: nationwide cohort study. BMJ (Clinical research ed). 2016;352:i276.
Verdoodt F, Jiang X, Williams M, Schnatz PF, Arbyn M. High-risk HPV testing in the management of atypical glandular cells: A systematic review and meta-analysis. International journal of cancer. 2016;138(2):303-10.
Arbyn M, Anttila A, Jordan J, Ronco G, Schenck U, Segnan N, et al. European Guidelines for Quality Assurance in Cervical Cancer Screening. Second edition--summary document. Ann Oncol. 2010;21(3):448-58.