title: Value of HPV-DNA test in women with cytological diagnosis of atypical glandular cells (AGC).
abstract: OBJECTIVE
  This study analyzed whether HPV (human papillomavirus) testing contributes towards defining histological abnormalities in women with atypical glandular cells (AGC) diagnosed at cervical cytology.
  
  
  METHODS
  One hundred and eight women with conventional cervical cancer screening smears suggestive of AGC not otherwise specified (AGC-NOS) and favor neoplastic (AGC-FN) were consecutively enrolled. All women underwent colposcopic examinations and biopsy was performed according to the cytopathologic and/or colposcopic abnormalities present. All specimens were tested for high risk HPV genotypes by Roche's polymerase chain reaction reverse line blot assay. The chi-square test was used to evaluate the association between HPV findings and a diagnosis of high-grade pre-invasive or invasive disease (CIN 2 or worse) taking negative tests or CIN 1 as a reference. Odds ratios (OR) with their respective 95% confidence intervals (95%CI) were used to evaluate the magnitude of the association between HPV testing and CIN 2 or worse. Sensitivity, specificity and their respective 95% confidence intervals (95%CI), positive predictive values (PPV) and negative predictive values (NPV) were also calculated.
  
  
  RESULTS
  Final diagnosis revealed a negative outcome in 80 cases (74%), cervical epithelial neoplasia 1 (CIN 1) in 13 cases (12%), CIN 2 or worse in 12 cases (11%) and glandular neoplasia in 3 (3%) cases. The overall detection rate of HPV was 21% (23/108). Neoplasia was significantly associated with positive HPV-DNA in women with AGC-NOS (OR=15.21; 95%CI: 2.64-87.50); however, there was no significant association between a histological diagnosis of neoplasia and HPV positivity in women with AGC-FN (OR=3.00; 95%CI: 0.36-24.92). The sensitivity, specificity, positive predictive value and negative predictive value of HPV-DNA testing for the detection of CIN 2 or worse in women with AGC-NOS were 71%, 86%, 29% and 97%, respectively. In women with AGC-FN, these values were 50%, 75%, 66% and 60%, respectively.
  
  
  CONCLUSIONS
  HPV testing at the time of colposcopy for patients with AGC in whom no colposcopic abnormality is found may be a powerful ancillary tool for identifying women at a high risk of underlying significant cervical lesions.
authors.affiliation: Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Rua Alexander Fleming, 101, 13.024-110 Campinas, São Paulo, Brazil. zeferino@fcm.unicamp.br
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: Zeferino
authors.forename: Silvia Helena
authors.initials: SH
authors.lastname: Rabelo-Santos
authors.forename: Luísa Lina
authors.initials: LL
authors.lastname: Villa
authors.forename: Luis Otávio
authors.initials: LO
authors.lastname: Sarian
authors.forename: Maria Cecília
authors.initials: MC
authors.lastname: Costa
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: do Amaral Westin
authors.forename: Liliana Aparecida Lucci
authors.initials: LA
authors.lastname: de Ângelo-Andrade
authors.forename: Sophie
authors.initials: S
authors.lastname: Derchain
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002584:Cervix Uteri / Q000473:pathology* / Q000821:virology*; D003127:Colposcopy; D004279:DNA, Viral / Q000378:metabolism*; D005260:Female; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009375:Neoplasms, Glandular and Epithelial / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D027383:Papillomaviridae / Q000302:isolation & purification*; D012306:Risk; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000821:virology
chemical_list: D004279:DNA, Viral