Analysis of 225 cases of cervical glandular lesions from the Papanicolaou test to total hysterectomy

Abstract Objective To explore the relative sensitivity of different methods for detecting cervical neoplasia including the Papanicolaou test, cervical biopsy and/or endocervical curettage (ECC), and the subsequent diagnosis following a loop electrosurgical excision procedure (LEEP), cold knife conization (CKC) or hysterectomy. Methods A total of 225 patients with cervical glandular lesions diagnosed from January 2018 to February 2023 were retrieved from the pathology database of Guangdong Maternal and Child Health Hospital, and their clinicopathological features were reviewed. Results Nineteen cases of cervical adenocarcinoma in situ (AIS), 71 cases of cervical adenocarcinoma (ADC) ，and 135 cases of mixed adenosquamous lesion (AIS or ADC complicated with low-grade squamous intraepithelial lesion(LSIL) or high-grade squamous intraepithelial lesion (HSIL) or squamous cell carcinoma (SCC) were identified. Their respective median ages were 38 and 46 years Four human papillomavirus (HPV) genotypes: HPV18, 16, 45, and 52, dominated all glandular lesions, and accounting for 72.09% of HPV-positive tumors. Furthermore,approximately one-third (36.89%) of abnormal squamous cells were diagnosed as abnormal based on cytological examinations leading to the detection of cervical glandular lesions; only 16.89% were diagnosed based on the initial detection of abnormal glandular cytology. The most common abnormal cervical screening result was ASC-US on cytology (14.22%), followed by HSIL (11.56%). Only afew number of patients were diagnosed with or suspected of having cervical adenopathy via a Pap test (18.22%). Nearly one-third of cervical glandular lesions cases were not detected on the Pap test; but were diagnosed upon cervical biopsy or based on the histological examination of ECC, LEEP, or CKC specimens. All 225 patients (100%) underwent biopsy and/or ECC, 120 patients (44.44%) underwent LEEP or CKC biopsy, and 178 (79.11%) undertook total hysterectomy. The LEEP or CKC biopsy specimens had negative margins in 49 cases (40.83%), while the margins were positive in the other 71 cases (59.17%). Five cases (10.20%) with negative margins still had residual lesions following total hysterectomy, and 19 (26.76%) with positive margins had no residual lesions after total hysterectomy. Conclusion Our results indicated that the ability to detect cervical glandular lesions varies for routine HPV genotyping, Pap test, or biopsy/ECC, with different sensitivities and advantages and disadvantages for each method. Further standardization is needed for cervical cancer screening in China.