Komatsu Hiroaki, Oishi Tetsuro, Osaku Daiken, Sawada Mayumi, Kudoh Akiko, Nonaka Michiko, Chikumi Jun, Sato Shinya, Harada Tasuku
Acta Cytol. 2018;62(5-6):405-410. doi: 10.1159/000490230. Epub 2018 Jul 10.
The aim of this study was to evaluate the diagnostic significance of high-risk human papillomavirus (hrHPV) testing for managing women with atypical glandular cells (AGC) and to explore the distribution of hrHPV genotypes.
We analyzed cytologic and histopathologic diagnoses in patients referred to our institution due to AGC or atypical squamous cells of undetermined significance (ASC-US). All patients underwent hrHPV testing and genotyping, and positive (PPV) and negative predictive values (NPV) for cervical intraepithelial neoplasia (CIN) 2 or worse [CIN2+/adenocarcinoma in situ (AIS)+] were calculated.
Among 41 cases previously diagnosed with AGC, 22 (53%) were classified as CIN2+ (2 squamous cell carcinomas), whereas only 2 were AIS or adenocarcinoma. Twenty-seven (65.8%) cases in the AGC group were hrHPV positive. The most frequent genotypes in both the ASC-US and AGC groups were HPV16 and HPV52. The PPV of hrHPV testing for CIN2+/AIS+ was significantly higher in the AGC than in the ASC-US group (74.1 vs. 35.0%; p = 0.0005). The NPV for CIN2+/AIS+ was significantly lower in the AGC than in the ASC-US group (74.4 vs. 100%; p = 0.0441).
In patients with AGC, both glandular and squamous lesions must be monitored. hrHPV testing is useful for detecting CIN2+/AIS+ in AGC.
本研究旨在评估高危型人乳头瘤病毒（hrHPV）检测对非典型腺细胞（AGC）女性患者管理的诊断意义，并探索hrHPV基因型的分布情况。
我们分析了因AGC或意义不明确的非典型鳞状细胞（ASC-US）转诊至我院的患者的细胞学和组织病理学诊断结果。所有患者均接受hrHPV检测和基因分型，并计算宫颈上皮内瘤变（CIN）2级或更高级别病变[CIN2+/原位腺癌（AIS）+]的阳性预测值（PPV）和阴性预测值（NPV）。
在41例先前诊断为AGC的病例中，22例（53%）被归类为CIN2+（2例为鳞状细胞癌），而仅有2例为AIS或腺癌。AGC组中27例（65.8%）病例hrHPV检测呈阳性。ASC-US组和AGC组中最常见的基因型均为HPV16和HPV52。AGC组中hrHPV检测对CIN2+/AIS+的PPV显著高于ASC-US组（74.1%对35.0%；p = 0.0005）。AGC组中CIN2+/AIS+的NPV显著低于ASC-US组（74.4%对100%；p = 0.0441）。
对于AGC患者，必须同时监测腺性和鳞状病变。hrHPV检测有助于在AGC患者中检测出CIN2+/AIS+。
