Harbhajanka Aparna, Dahoud Wissam, Michael Claire W
Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
Diagn Cytopathol. 2019 Oct;47(10):1028-1036. doi: 10.1002/dc.24268. Epub 2019 Jul 30.
The cytology diagnosis of glandular cell abnormalities (GCAs) is diagnostically challenging, causing inadequate reproducibility. Histological outcome of GCA on cytology varies from benign to malignant diseases. The goal of this study is to evaluate histological outcome and identify distinctive cohorts of patients with GCA based on human papillomavirus (HPV) status, age, and associated squamous abnormality to stratify the patient into high risk for squamous/glandular lesions.
From 2012 to 2017, out of 162 088 ThinPrep Papanicolaou tests performed, 998 (0.61%) were reported as GCAs. Histologic follow-up was available in 638 cases and 429 had concurrent HPV results.
The overall rate of high-risk human papillomavirus (hrHPV)-positivity (hrHPV+) was 33.6% (144/429 cases). Among the hrHPV+ cases, 18.1% had cervical intraepithelial neoplasia 2/3 (CIN2/3), 3.5% squamous cell carcinoma (SCC), 3.5% cervical adenocarcinoma in situ (AIS)/adenocarcinoma (ADC), and 2.8% endometrial carcinoma. Among hrHPV- cases, 1.4% had CIN2/3, 1.1% AIS/ADC, and 17.5% endometrial carcinoma. The high-grade cervical lesions (CIN2/3/AIS/ADC) were significantly higher in women with hrHPV+ and associated squamous abnormalities compared to hrHPV- and no squamous abnormality in all age groups except patients >65 years. Endometrial carcinoma was most commonly present in women >65 years especially with HPV- and no associated squamous abnormalities.
HPV testing is useful for predicting the risk of high-grade cervical neoplasia in women with GCA especially with associated squamous abnormalities on cytology. The endometrial carcinoma is more frequent in hrHPV- older women. The combination of cytology with knowledge of associated squamous abnormality, hrHPV status, and age can significantly aid in stratifying the patient into high risk for glandular/squamous lesions which facilitates appropriate management of these patients.
腺细胞异常（GCA）的细胞学诊断具有挑战性，重复性欠佳。GCA的细胞学组织学结果涵盖从良性到恶性的多种疾病。本研究旨在评估组织学结果，并基于人乳头瘤病毒（HPV）状态、年龄及相关鳞状上皮异常情况，识别出不同的GCA患者队列，从而将患者分为鳞状上皮/腺性病变的高危人群。
2012年至2017年期间，在162088例液基薄层巴氏试验中，有998例（0.61%）报告为GCA。638例有组织学随访结果，429例有HPV检测结果。
高危人乳头瘤病毒（hrHPV）阳性（hrHPV+）率为33.6%（144/429例）。在hrHPV+病例中，18.1%有宫颈上皮内瘤变2/3级（CIN2/3），3.5%为鳞状细胞癌（SCC），3.5%为宫颈原位腺癌（AIS）/腺癌（ADC），2.8%为子宫内膜癌。在hrHPV-病例中，1.4%有CIN2/3，1.1%有AIS/ADC，17.5%为子宫内膜癌。除65岁以上患者外，所有年龄组中，hrHPV+且伴有鳞状上皮异常的女性高级别宫颈病变（CIN2/3/AIS/ADC）显著高于hrHPV-且无鳞状上皮异常的女性。子宫内膜癌最常见于65岁以上女性，尤其是hrHPV-且无相关鳞状上皮异常者。
HPV检测有助于预测GCA女性发生高级别宫颈肿瘤的风险，尤其是细胞学检查伴有相关鳞状上皮异常者。hrHPV-的老年女性子宫内膜癌更为常见。将细胞学检查与相关鳞状上皮异常情况、hrHPV状态及年龄相结合，可显著有助于将患者分为腺性/鳞状病变的高危人群，从而便于对这些患者进行适当管理。
