How Useful Is Reflex HPV Testing in Patients with Atypical Glandular Cells of Undetermined Significance?
Saraswati Pokharel, Mana MoghadamFalahi, Houda Alatassi. University Hospital Louisville, Louisville
Background: Cytologic interpretation of atypical glandular cells (AGC) indicates the presence of atypical glandular cells that mostly originate from the endocervix or the endometrium. Current guidelines recommend immediate colposcopy and endocervical with/or without endometrial sampling along with high risk human papiloma virus (HR-HPV) testing for follow up in patients with AGC. Recently, a few small studies suggested that HR-HPV DNA testing alone may also be used to triage patients with AGC. In the current study, we aim to investigate whether HR-HPV testing in the AGC population identifies patients with risk for cervical dysplasia/neoplasia.
Design: We retrospectively identified all patients with cervical cytology diagnosis of AGC within 61 consecutive months between Jan 2006 and Feb 2011. HR-HPV DNA test results and follow up biopsy data were analyzed.
Results: Of the 17,823 pap tests, 119 were reported as AGC and 1693 as atypical squamous cells (ASC), which corresponds to AGC to ASC ratio of 0.07. Ninety patients (75%) received a follow up biopsy. Thirty two (35%) patients had reflex HR-HPV testing of which 5 cases were HR-HPV positive, 26 cases were HR-HPV negative and 1 case had an equivocal results. Out of 32 cases, there were 24 (26%) patients who underwent HR-HPV testing and follow up biopsy. Four out of 24 patients (16%) who had AGC on pap smear and were negative for HR-HPV testing had cervical dysplasia or invasive squamous cell carcinoma. Positive predictive value of HR- HPV testing in AGC for detection of cervical dysplasia is 100%. Negative predictive value of HR-HPV negative for the absence of squamous dysplasia is 81%. The sensitivity of HR-HPV test is 42% and specificity is 100% in AGC.
|Biopsy diagnosis||HPV +||HPV -|
|No follow up biopsy||2||5|