A Retrospective Analysis of 1151 Chinese Women With Atypical Glandular Cells: Impact of High‐Risk Human Papilloma Virus Status and Age on Cervical and Endometrial Neoplasia Risk

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doi:10.1002/dc.25495

ABSTRACT

Objective

To investigate the clinical significance of high‐risk human papillomavirus (hrHPV) testing and age in women with atypical glandular cells (AGC) on Pap tests.

Methods

We retrospectively analyzed the relationship between hrHPV and cytology co‐testing, follow‐up histopathology within 6 months, age, and other demographic features in a large cohort of AGC patients from a single Chinese academic institution.

Results

Among1510 AGC patients, 1151, 1260, and 866 patients had histopathologic results, hrHPV co‐testing, and both, respectively. High‐grade squamous intraepithelial lesions (HSIL)/adenocarcinoma in situ (AIS) and worse lesions (HSIL/AIS+) and endometrial atypical hyperplasia (EAH)/endometrial carcinoma (EC) (EAH/EC+) were present in 27.8% (281/1009) and 25.1% (113/450) patients, respectively. hrHPV was positive in 34.5% (435/1260) patients. Among hrHPV+ patients with genotyping by the Aptima assay, 48.8% (125/256) had HPV16 and/or 18/45. Compared to hrHPV− patients, hrHPV+ women had a significantly increased risk of HSIL/AIS+ (OR: 10.958, 95% CI: 7.657–15.682), particularly with HPV16 and/or18/45 (OR: 3.556, 95% CI: 2.122–5.959; both p < 0.001). Among hrHPV− patients, those aged ≥ 40 years had higher risks of HSIL/AIS+ (including 18 HPV‐independent and 11 metastatic adenocarcinomas; OR: 5.882, 95% CI: 2.702–12.806) and EAH/EC+ (OR: 7.622, 95% CI: 3.188–18.225) compared to younger patients (both p < 0.001).

Conclusions

Combining hrHPV testing and age effectively stratifies risks in AGC patients: hrHPV positivity predicts high‐grade cervical lesions, while older hrHPV‐negative women are more likely to have endometrial or extra‐uterine malignancies. These findings may optimize management of AGC patients with cumulative supportive data.