The impact of HPV-specific infection in women diagnosed with atypical glandular cells: Results from the HPV-AGC study

Bogani, Giorgio; Sopracordevole, Francesco; Casarin, Jvan; Pinelli, Ciro; Maggiore, Umberto Leone Roberti; Brusadelli, Claudia; Guerrisi, Rocco; Ditto, Antonino; Dell’Acqua, A.; Serati, Maurizio; Lopez, Salvatore; Ferrero, Simone; Ghezzi, Fabio; Raspagliesi, Francesco

doi:10.1016/j.prp.2020.153184

Cited by 7 publications

(6 citation statements)

References 16 publications

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“…Several recent studies have further strengthened the evidence indicating that HPV is a strong progression marker among women with AGC. 18,19 We have previously reported a follow-up that was restricted to primary cytology screening 20 and reported a similar proportion of HPV-positive AGC (56%). The major difference compared our older study was that the proportion of women with AGC that had actually been followed up had increased (84% in the present study, compared with 70% in the older study).…”

Section: Strengths and Limitationsmentioning

confidence: 82%

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Atypical glandular cells and development of cervical cancer: Population‐based cohort study

Norman

Yılmaz

Hjerpe

et al. 2022

Intl Journal of Cancer

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The effect of cervical screening on cervical adenocarcinoma has been variable, possibly because the risk associated with the precursor atypical glandular cells (AGC) is not well known. A cohort of all 885 women in the capital region of Sweden with AGC, a concomitant human papillomavirus (HPV) analysis, and a histopathology was followed until 2019. Cumulative incidence proportions of cervical intraepithelial lesion grade 3 or worse (CIN3+) by HPV type was determined by 1-Kaplan-Meier estimates. Hazard ratios (HR) for CIN3+ or for invasive cancer were estimated with Cox regression. After 2 years of follow-up, the cumulative incidence proportions of CIN3+ were 80% (95% confidence interval [CI]: 74-86%), 58% (95% CI: 50-60%) and 10% (95% CI: 5-18%) among HPV16/18 positive, "other HPV" positive and HPV-negative women, respectively. Among the 300 women with HPV16/18 positive AGC, 217 developed CIN3+ of which 35 were invasive cervical cancer. The 2-year cumulative invasive cancer risk for HPV16/18 positive AGC was 17% (95% CI: 12-24%). Primary HPV-screening had a similar yield of CIN3+ as cytology screening, albeit HPV-negative AGC is by design not detected by HPV screening. Among 241 women with HPV-negative AGC, 11 developed CIN3+ mostly after clinically indicated samples. We found no significant risk differences depending on age or sampling indication. The low CIN3+ risk after HPV-negative AGC implies safety of primary HPV screening. The high risk of invasive cervical cancer after HPV16/18 positive AGC implies that management of this finding is a priority in cervical screening.

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Section: Strengths and Limitationsmentioning

confidence: 82%

“…Several recent studies have further strengthened the evidence indicating that HPV is a strong progression marker among women with AGC. 18 , 19 …”

Section: Discussionmentioning

confidence: 99%

Atypical glandular cells and development of cervical cancer: Population‐based cohort study

Norman

Yılmaz

Hjerpe

et al. 2022

Intl Journal of Cancer

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“…A case–control study from the United States conducted by Namugenyi et al 24 found HPV45 and 68 to be most common high-risk HPV types after HPV16 among 18 high-risk–positive women with AGC. A multi-institutional retrospective study by Bogani and colleagues 25 from Italy found HPV58 and HPV31 to be the most common types after HPV16/18 among 136 AGC cases with positive HPV DNA testing. In our study with a comparatively larger study population, we found HPV31 and HPV45 to be the most frequent types among women with AGC and positive for other HPV types.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Human Papillomavirus Non-16/18, Type-Specific Risk for Cervical Intraepithelial Neoplasia Grade 3 or Worse Among Women With Cervical Atypical Glandular Cells

Yılmaz

Lagheden

Ghaderi

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To evaluate the risk for cervical intraepithelial neoplasia grade 3 (CIN 3) or worse (including adenocarcinoma in situ [AIS] and invasive cervical cancer) associated with non-16/18 human papillomavirus (HPV) types (other HPV) among women with atypical glandular cells (AGC) in cervical cytology. METHODS: This population-based cohort study evaluates the risk of CIN 3 or worse associated with other HPV types. Human papillomavirus genotyping was performed on Pap tests collected in Sweden from 341 women with AGC that were positive for other HPV types from February 17, 2014, to December 31, 2018. The women were followed for histopathologic outcomes using comprehensive registry linkages until December 31, 2019. Cumulative incidence proportions of CIN 3 or worse by specific HPV type were calculated using 1-minus Kaplan-Meier function. Hazard ratios (HRs) for CIN 3 or worse were generated using multivariate Cox regression. RESULTS: Of 341 women, 134 (39.3%) had CIN 3–AIS, but there were only five (1.5%) women in the cohort with invasive cervical cancer. Human papillomavirus 45 preceded 80.0% of invasive cervical cancer cases. Among women positive for HPV33, 82.9% (95% CI 58.0–97.3%) had CIN 3 or worse during follow-up. Positivity for HPV31 conferred the highest HR for CIN 3 or worse relative to other types, both in primary cytology and primary HPV screening (HR 2.71, 95% CI 1.47–5.00 and HR 3.41, 95% CI 1.95–5.96, respectively). CONCLUSION: Among non-16/18 HPV types in AGC, HPV31 and 33 had the highest risk for CIN 3 or worse, whereas most of the women with invasive cancer were positive for HPV45. Extended HPV genotyping may be helpful for the management of AGC.

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“…However, positive ectocervical margin also significantly impacted the risk of developing persistent/recurrent disease. Moreover, we have to take into consideration that the severity of the dysplasia might correlate with the size of the cervical lesions [30][31][32][33].…”

Section: Discussionmentioning

confidence: 99%

Development of a Nomogram Predicting the Risk of Persistence/Recurrence of Cervical Dysplasia

et al. 2022

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Background: Cervical dysplasia persistence/recurrence has a great impact on women’s health and quality of life. In this study, we investigated whether a prognostic nomogram may improve risk assessment after primary conization. Methods: This is a retrospective multi-institutional study based on charts of consecutive patients undergoing conization between 1 January 2010 and 31 December 2014. A nomogram assessing the importance of different variables was built. A cohort of patients treated between 1 January 2015 and 30 June 2016 was used to validate the nomogram. Results: A total of 2966 patients undergoing primary conization were analyzed. The median (range) patient age was 40 (18–89) years. At 5-year of follow-up, 6% of patients (175/2966) had developed a persistent/recurrent cervical dysplasia. Median (range) recurrence-free survival was 18 (5–52) months. Diagnosis of CIN3, presence of HR-HPV types, positive endocervical margins, HPV persistence, and the omission of HPV vaccination after conization increased significantly and independently of the risk of developing cervical dysplasia persistence/recurrence. A nomogram weighting the impact of all variables was built with a C-Index of 0.809. A dataset of 549 patients was used to validate the nomogram, with a C-index of 0.809. Conclusions: The present nomogram represents a useful tool for counseling women about their risk of persistence/recurrence after primary conization. HPV vaccination after conization is associated with a reduced risk of CIN2+.

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The impact of HPV-specific infection in women diagnosed with atypical glandular cells: Results from the HPV-AGC study

Cited by 7 publications

References 16 publications

Atypical glandular cells and development of cervical cancer: Population‐based cohort study

Atypical glandular cells and development of cervical cancer: Population‐based cohort study

Assessment of Human Papillomavirus Non-16/18, Type-Specific Risk for Cervical Intraepithelial Neoplasia Grade 3 or Worse Among Women With Cervical Atypical Glandular Cells

Development of a Nomogram Predicting the Risk of Persistence/Recurrence of Cervical Dysplasia

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