Zhong Fangfang, Zilla Megan L, Sun Yihua, Zeng Xianxu, Zhang Hao, Xiao Jianan, Tao Xiang, Zhao Chengquan
Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Department of Pathology, The Third Affiliated Hospital of Zhengzhou University; Zhengzhou, China.
J Low Genit Tract Dis. 2025 Jul 1;29(3):223-228. doi: 10.1097/LGT.0000000000000886. Epub 2025 Apr 1.
This study aims to evaluate the risk of cervical glandular neoplasia with extended high-risk human papillomavirus (hrHPV) genotyping, in patients with atypical glandular cells (AGC) cytology.
Cervical AGC cases with concurrent extended HPV genotyping between October 2017 and October 2023 were retrieved from the archives of Department of Pathology, Obstetrics, and Gynecology Hospital of Fudan University (OGHFU).
A total of 497 AGC cases with extended hrHPV genotyping showed an hrHPV-positive rate of 32.0%. The top 4 hrHPV types were HPV18, 16, 52, and 59. A total of 304 cases had histological follow-up. A total of 72 cases (23.7%) had cervical adenocarcinoma in situ/cervical intraepithelial neoplasia3 or worse (AIS/CIN3+) lesions with 43 endocervical carcinoma (EC-ADC), 28 AIS, and 1 CIN3. Cervical AIS/CIN3+ lesions were detected in 50.5% (55/109) of the hrHPV-positive group. Women with HPV18/16/45 positivity had 77.6% cumulative risk of cervical AIS/CIN3 + lesions (52/67), accounting for 94.6% (52/55) of the total hrHPV-associated cervical AIS/CIN3+ lesions. For all 15 other hrHPV types, the overall risk of AIS/CIN3+ was 7.1% (3/42 cases). The sensitivity, specificity, PPV, and NPV of the composite HPV18/16/45 group for detecting endocervical glandular neoplasia was 71.8%, 93.1%, 76.1%, and 91.6%, respectively. Endocervical carcinoma was found in 17 of 195 (8.7%) women with negative hrHPV testing, accounting for 39.5% EC-ADC (17/43) cases.
Atypical glandular cells was rarely related to CIN3. Atypical glandular cells was strongly related to AIS and EC-ADC. Women aged 30-49 years had highest risk for AIS/CIN3+ lesions. Although HPV test can be helpful, there were still some cases of HPV-negative endocervical adenocarcinomas. Extended HPV genotyping in AGC cases identified certain HPV types associated with a higher risk of cervical glandular lesions, potentially assisting with risk stratification.
本研究旨在评估非典型腺细胞（AGC）细胞学患者中，通过扩展的高危型人乳头瘤病毒（hrHPV）基因分型检测宫颈腺上皮肿瘤的风险。
从复旦大学附属妇产科医院病理科档案中检索2017年10月至2023年10月期间同时进行扩展HPV基因分型的宫颈AGC病例。
497例进行扩展hrHPV基因分型的AGC病例中，hrHPV阳性率为32.0%。前4种hrHPV类型为HPV18、16、52和59。共有304例进行了组织学随访。共有72例（23.7%）患有宫颈原位腺癌/宫颈上皮内瘤变3级或更严重（AIS/CIN3+）病变，其中43例为宫颈管腺癌（EC-ADC），28例为AIS，1例为CIN3。在hrHPV阳性组中，50.5%（55/109）检测到宫颈AIS/CIN3+病变。HPV18/16/45阳性的女性发生宫颈AIS/CIN3 +病变的累积风险为77.6%（52/67），占hrHPV相关宫颈AIS/CIN3+病变总数的94.6%（52/55）。对于其他15种hrHPV类型，AIS/CIN3+的总体风险为7.1%（3/42例）。HPV18/16/45组合检测宫颈管腺上皮肿瘤的敏感性、特异性、阳性预测值和阴性预测值分别为71.8%、93.1%、76.1%和91.6%。195例hrHPV检测阴性的女性中有17例（8.7%）被诊断为宫颈管腺癌，占EC-ADC病例的39.5%（17/43）。
非典型腺细胞与CIN3的相关性较低。非典型腺细胞与AIS和EC-ADC密切相关。30 - 49岁女性发生AIS/CIN3+病变的风险最高。尽管HPV检测可能有帮助，但仍有一些宫颈管腺癌病例HPV检测为阴性。对AGC病例进行扩展的HPV基因分型可识别出某些与宫颈腺上皮病变风险较高相关的HPV类型，可能有助于风险分层。
