The relationship of human papillomavirus infection with endocervical glandular involvement on cone specimens in women with cervical intraepithelial neoplasia

• Published in: Gynecologic oncology Vol. 159; no. 3; pp. 630 - 635
• Main Authors: Spinillo, Arsenio, Dominoni, Mattia, Boschi, Anna Chiara, Cesari, Stefania, Fiandrino, Giacomo, Gardella, Barbara
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2020
• Subjects: Adult; Cervical Intraepithelial Neoplasia - epidemiology; Cervical Intraepithelial Neoplasia - pathology; Cervical Intraepithelial Neoplasia - surgery; Cervical Intraepithelial Neoplasia - virology; Cervix Uteri - pathology; Cervix Uteri - virology; CIN; Colposcopy; Conization - statistics & numerical data; DNA, Viral - isolation & purification; Endocervical glandular involvment; Endometrium - pathology; Endometrium - virology; Female; Follow-Up Studies; Hematology, Oncology, and Palliative Medicine; Human papillomavirus 16 - genetics; Human papillomavirus 16 - isolation & purification; Humans; Middle Aged; Multiple HR HPV infection; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - virology; Obstetrics and Gynecology; Papillomavirus Infections - diagnosis; Papillomavirus Infections - epidemiology; Papillomavirus Infections - pathology; Papillomavirus Infections - virology; Prospective Studies; Uterine Cervical Neoplasms - epidemiology; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery; Uterine Cervical Neoplasms - virology; CIN; Endocervical glandular involvment; Multiple HR HPV infection
• ISSN: 0090-8258; 1095-6859; 1095-6859
• DOI: 10.1016/j.ygyno.2020.09.034

The aim of study was to evaluate the association of endocervical gland involvement (EGI) on histological samples with high risk (HR) human papillomavirus (HPV) infection and with the persistence/recurrence rate of cervical intraepithelial neoplasia (CIN) after treatment. A total of 1301 subjects who had conization procedures after cervical punch biopsies (533 persistent CIN1, 768 CIN2+ including 20 microinvasive cervical cancer) were enrolled in the study. HPV genotypes were identified using the INNO-LiPA HPV genotyping assay on cervical scraping. Logistic regression and Cox regression analyses were used to evaluate the association of EGI on the persistence/recurrence rate of CIN after treatment. The rate of EGI on final histology was 46.3% (602/1301). HPV 16 was the only HR-HPV significantly associated with increasing rates of EGI (231/602 as compared to 211/699, p = 0.002). EGI was also associated with an excess of multiple HR-HPV infections (237/602 as compared with 225/699, p = 0.006). After correction for confounders, the odds ratio of EGI among women infected by HPV 16 was 1.41 (95% CI = 1.12–178). CIN2+ lesions were diagnosed in 40.5% (283/699) of EGI negative subjects and 86.7% (522/602, p < 0.001 compared to negative subjects) of EGI positive subjects.After a median of 25 months of follow-up (IQR = 15–47) of 1090 treated women, the persistence of HPV 16 during follow-up was 38.1% (93/217, p = 0.03 compared to EGI negative) among EGI positive and 32% (58/181) among controls. After corrections for potential confounders, the odds ratio of CIN2+ persistence and or recurrence was higher among EGI positive (OR = 2.35, 95% CI = 1.16–4.77) than negative controls. EGI on histological samples is associated with increased rates of HPV 16, multiple high risk-HPV infections and CIN2+ lesions. EGI positive subjects also had an increased CIN recurrence/persistence after treatment compared to controls. •Endocervical gland involvement increased the risk of treatment failure during follow up.•High risk multiple HPV infection is associated to endocervical gland involvement.•Endocevical glandular involvement on histological samples is associated with an increased incidence/persistence of HPV 16.•The involvement of endocervical gland is related to an increased incidence of positive margins on cone specimens.