Use of Human Papillomavirus Testing in the Management of Atypical Glandular Cells

Abstract

To analyze the role of human papillomavirus (HPV) testing in the management of women with atypical glandular cells (AGCs). After institutional review board approval, cases of AGC with concurrent HPV testing were identified from the pathology database at Hartford Hospital from January 2000 to September 2006, inclusive. Atypical glandular cell-associated disease included cervical intraepithelial neoplasia 2 (CIN 2) or anything of greater pathologic importance on histology. Human papillomavirus-associated disease included CIN 2-3, glandular atypia, adenocarcinoma in situ, or any cervical malignancy. Two hundred fourteen cases of AGC with concurrent HPV testing were evaluated, including 27 cases of AGC with concurrent atypical squamous cells, low-grade squamous intraepithelial lesions, or high-grade squamous intraepithelial lesions. The rate of disease was 20.6%, with a 7.0% prevalence of cancer. Among the 214 cases of AGC, 30.4% tested positive for HPV. The rate of HPV-associated disease among cases testing positive for HPV was 40.0% compared with 4.0% among HPV-negative cases. The sensitivity of HPV testing for HPV-associated disease was 81.3%. Women positive for human papillomavirus were less likely to have endometrial or extrauterine disease (1.5%) than HPV-negative women (7.4%). All women with AGC on cervical cytology require colposcopy and endocervical curettage regardless of HPV status. Women positive for human papillomavirus are at higher risk than HPV-negative women for cervical disease and should be evaluated and followed up closely. Women at risk for endometrial or extrauterine malignancies should undergo appropriate evaluation regardless of HPV status.