The Utility of Human Papillomavirus Testing in the Management of Atypical Glandular Cells on Cytology

Abstract

To determine the value of human papillomavirus (HPV) testing for HPV-associated cervical disease (HPV-AD) and overall disease (atypical glandular cell [AGC]-associated cervical disease) in women with AGCs. A literature search was conducted from January 1993 through September 2007 using various AGC-related terms with the exploded Medical Subject Heading (MeSH) term "HPV." Findings from 7 studies were used to calculate disease rates according to HPV status. The rate of AGC-associated cervical disease for 661 cases of AGC with concurrent HPV testing was 23.3%. The rate of HPV-AD was higher in HPV-positive, versus negative, cases (53% vs 3%, respectively). Human papillomavirus-positive, versus negative, status predicted a higher likelihood of a cervical intraepithelial neoplasia 2/3 lesion (odds ratio = 39.6, 95% CI = 17.9-87.4, p <.001). The rate of HPV-nonassociated cancers was significantly higher in patients who were negative, versus positive, for HPV (4% vs 0.4%; p =.016). Human papillomavirus testing had an overall 90% sensitivity, 79% specificity, 53% positive predictive value, and 97% negative predictive value for cases of HPV-AD. Atypical glandular cell with concurrent atypical squamous cell (ASC) or squamous intraepithelial lesion (SIL) (ASC/SIL) had higher rates of disease than AGC alone. The positive predictive value of HPV testing for AGC with concurrent ASC/SIL was higher than that for AGC alone. All women with AGC should undergo a comprehensive initial examination regardless of HPV status. The presence of HPV identifies a group of women at higher risk for cervical disease who should be followed closely. Women positive for human papillomavirus with AGC and concurrent ASC/SIL are at even higher risk. If, after a comprehensive initial examination, women with AGC not-otherwise-specified and positive HPV have no identifiable disease, a cervical conization may be considered.