Endocervical Adenocarcinoma In Situ and Invasive Adenocarcinoma: The Significance of HPV-DNA Results.
Andrew T Turk, Jonas J Heymann, John P Crapanzano, Anjali A Saqi. Columbia University, New York, NY
Background: The association between adenocarcinoma in situ (AIS)/endocervical adenocarcinoma (ADCA) and human papillomavirus (HPV) is well established. The 2006 guidelines of the American Society for Colposcopy and Cervical Pathology recommend colposcopy and endocervical sampling for all cases of atypical glandular cells (AGC)/AIS. Previous studies have shown that significant pathologic lesions occur more frequently on follow-up biopsies in cases with AGC on cytology and positive HPV DNA testing, compared to cases with negative HPV testing. Outcomes of HPV testing, however, do not alter management of AGC. The aim of our investigation is to expand upon conclusions of prior studies regarding the sensitivity of HPV testing by selecting histologically confirmed AIS/ADCA and retrospectively assessing the results of HPV DNA testing.
Design: We searched archived material at our institution for cases of AIS/ADCA diagnosed on biopsy or hysterectomy over a five-year period. We then determined whether hybrid capture HPV DNA testing was performed, reviewed the cytologic diagnosis rendered on the corresponding specimen, and recorded the interval between HPV testing and biopsy/hysterectomy.
Results: We identified 3 and 22 cases of AIS and invasive ADCA, respectively. Of these 25 cases, 9 had corresponding HPV testing. Up to 3 HPV assays were performed per patient, yielding a total of 13 HPV assays. Of these, 9 were performed prior to the diagnosis of ADCA/AIS. Seven of these were positive, and 2 were negative. For the 7 HPV(+) cases, the corresponding cytologic diagnoses included 1 case each of ADCA, AGC, LSIL, and ASCUS, and 3 cases with no intraepithelial lesion. For the 2 HPV-negative cases, the respective cytologic diagnoses were ASCUS/AGC and no intraepithelial lesion. For the 7 HPV(+) cases, the interval between HPV testing and histologic diagnosis of carcinoma ranged from 18-353 days (average = 5 months). The period between HPV testing and histologic diagnosis was 331 days and 1145 days (average = 24 months) for the 2 HPV(-) cases.
Conclusions: Of 9 HPV assays corresponding to subsequently diagnosed cases of ADCA and AIS, 7 were positive (including all cases in which the interval between HPV testing and biopsy/hysterectomy was less than 11 months), and 2 were negative (including all cases in which the interval was greater than 11 months). These findings strengthen the association between HPV(+) results and presence of significant pathologic lesions such as AIS/ADCA, and provide further evidence supporting the relevance of HPV(+) results in terms of patient management.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 102, Tuesday Morning