Assessment of risk factors for high-grade cervical or endometrial lesions to triage women with AGC-FN: a retrospective study.

Abstract

Background: Atypical glandular cells, favor neoplastic (AGC-FN) identified in Papanicolaou (Pap) smears may be indicative of pre-malignant and malignant cervical and endometrial lesions. However, an effective strategy for triaging patients with AGC-FN remains elusive. This study aimed to analyze the relationship between AGC-FN and high-grade lesions, as well as identify specific risk factors which can optimize the currently strategy in women with AGC-FN.

Methods: This retrospective utilized data from the China's Fujian Cervical Pilot Project (FCPP). A total of 211 women diagnosed with AGC-FN according to the Bethesda 2014 classification system underwent follow-up through colposcopy, biopsy, and endometrial curettage between January 2013 and July 2021. The association between high-grade lesions and clinicopathologic features were analyzed using independent sample nonparametric tests and binary logistic regression. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of different triage strategie were evaluated.

Results: There were 43.60% (92/211) and 27.96% (59/211) AGC-FN women diagnosed as ≥ endometrial precancerous lesions (≥ EPL) and CIN2 + , respectively. In women with ≥ EPL, the top 3 risk factors were higher HE4, higher CA125 and older age (adjusted odds ratio [OR_adjusted]: 3.351, 2.760, 1.124, all p < 0.05, respectively). The top 3 risk factors for ≥ HISL women were HPV-16/18 infection, HPV-16/18/58/59 infection and HR-HPV infection (OR_adjusted: 50.122, 40.043, 37.011, all p < 0.01, respectively). Interestingly, the age, CA125 and HR-HPV infection showed opposite roles in AGC-FN women with ≥ EPL and ≥ HISL. When using ≥ EPL and ≥ HISL as endpoints, strategies 2 and 4 had the highest sensitivities of 97.3% and 95.3% and highest NPV of 80.0% and 97.3% by incorporating specific risk factors, respectively. Moreover, the referral rates of strategies 1, 3 and 4 were significantly lower (76.5%, 38.0% vs 62.8%, p < 0.05).

Conclusion: CA125 and HR-HPV infection emerged as significant risk factors for triaging women with AGC-FN and HPV-16 and -18, HPV-58 and -59 infections should not to be overlooked. A novel triage strategy combining CA125, CA199, HE4 and HR-HPV reduced the referral rates of biopsy and curettage without altering the original sensitivity.