Pregnant and postpartum women with atypical glandular Cells: Follow-up and Evaluation for high-risk HPV

Objectives: The study was an attempt: to find out the prevalence of atypical glandular cells of undetermined significance (AGC) in cervicovaginal smears of pregnant and postpartum women in Duhok-Iraq; follow up these women to investigate the underlying pathology and to test for high-risk HPV (HR-HPV). Methods: From May 2005 to June 2013, all Pap smears of pregnant and postpartum women were analyzed and women with AGC cytology were enrolled in the study. One hundred and fifty two women, for whom follow up was possible, were subjected to colposcopic directed cytology and/or histology for at least 48 months from the initial reading. Their results were comprehensively evaluated, and HR-HPV DNA testing was performed by conventional PCR in 56 cases. Results: Overall, AGC cytology formed 6.7% of all pregnant and postpartum women’s Pap smears and 29.6% were at risk for neoplastic epithelial lesions (AGC and premalignant lesions). The diagnosis of ≥ low squamous intraepithelial lesion (LSIL) was observed in 14.5% of cases among whom significantly high frequency of HR-HPV DNA was noted compared with those having persistent AGC or negative atypia (NILM). Conclusions: Identical to non-pregnant women, pregnant and postpartum women with AGC cytology are at risk of harboring premalignant and malignant (squamous or glandular) lesions, and testing of AGC cytologic specimens for HR-HPV might help predict neoplastic cases but not to distinguish malignant from premalignant lesions.