Atypical glandular cells of undetermined significance. Outcome predictions based on human papillomavirus testing.
Cases of atypical glandular cells (AGC) diagnosed on liquid-based preparations were culled from a 3-year period. When available, residual cellular material was analyzed for human papillomavirus (HPV) by polymerase chain reaction and correlated with cytologic and histologic (biopsy) outcome. Of 178,994 cytologic cases, 187 (0.1045%) contained AGC compared with 8,740 (4.8828%) atypical squamous cells (ASC) for an AGC/ASC ratio of 0.021. HPV results and follow-up were available for 108 specimens from 106 patients. Depending on the end-point (histologic/cyto-logic), the sensitivity range of HPV testing for significant cervical disease (high-grade squamous intraepithelial lesion [SIL], adenocarcinoma in situ [ACIS], invasive carcinoma) was 83% with a specificity range of 78% to 82%, a positive predictive value of 57% to 61%, and a negative predictive value of 91% to 95%. Fifteen false-positive results included concurrent ASC or low-grade SIL, ASC on follow-up cytology, and previous ACIS with a negative follow-up cone biopsy result. Noncervical glandular neoplasia (including atypical endometrial hyperplasia) was confirmed in 13 cases (1 recurrent), only 2 of which scored positive for HPV. HPV-positive AGC has a substantially higher positive predictive value for significant disease than ASC (61% vs historic 20%) and merits consideration in the triage of patients with atypical endocervical cells not otherwise specified. However, noncervical or other HPV-negative glandular neoplasia must be considered in all patients with AGC, particularly older patients.
Krane
Jeffrey F
JF
Divisions of Women's and Perinatal Pathology and Cytology, Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.
Lee
Kenneth R
KR
Sun
Deqin
D
Yuan
Liping
L
Crum
Christopher P
CP
D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008403:Mass Screening; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000150:complications / Q000473:pathology*; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D016037:Single-Blind Method; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000821:virology / Q000150:complications; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000821:virology; D014626:Vaginal Smears / Q000145:classification / Q000379:methods
D004279:DNA, Viral