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Correlation of immediate prevalence of cervical precancers and cancers with HPV genotype and age in women with ASC-US/hrHPV+: a retrospective analysis of 2292 cases
  1. Qin Liu1,
  2. Tao Zhang2,
  3. Liqing Chen2,
  4. Xin Zhou1,
  5. Xiaofei Zhang1,
  6. Wenxin Zheng3,4,
  7. Shuang Niu3,4,
  8. Feng Zhou1
  1. 1 Department of Pathology, Zhejiang University School of Medicine Women’sHospital, Hangzhou, Zhejiang, China
  2. 2 Department of Gynecology, Zhejiang University School of Medicine Women’s Hospital, Hangzhou, Zhejiang, China
  3. 3 Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
  4. 4 Department of Pathology, Parkland Hospital, Dallas, Texas, USA
  1. Correspondence to Dr Feng Zhou, Zhejiang University School of Medicine Women’s Hospital, Hangzhou, Hangzhou 310006, China; fungchew{at}


Aims To stratify the risk of cervical precancers (high-grade squamous intraepithelial lesion (HSIL) and adenocarcinoma in situ (AIS)) and cancers (squamous cell carcinoma (SCC) and adenocarcinoma) based on distinct high-risk human papillomavirus (hrHPV) genotypes as well as age groups among women with atypical squamous cells of undetermined significance (ASC-US) and hrHPV+results.

Methods In total, 2292 cases of ASC-US/hrHPV+ with immediate follow-up biopsy results were included in the study for prevalence analysis.

Results Overall, 12.2% women with ASC-US /hrHPV+ had HSIL+ while 0.22% had AIS+ lesions. The HPV-16+ group (31.6%) showed significantly higher prevalence of HSIL+ squamous lesions than other genotype groups (p<0.0001). The prevalence of SCC is significantly higher in HPV-16+ (1.8%) or HPV-18/45+ (1.1%) group than women in other genotype groups (0.1%) (p<0.0001). The HPV-18/45+ group (1.7%) showed significantly higher prevalence of AIS+ glandular lesions than other genotype groups (p=0.003). In addition, SCC prevalence was significantly higher in age over 50 group than that in age under 50 group (1.2% vs 0.2%, p=0.012).

Conclusion Women with ASC-US/hrHPV+ are at significant risk of cervical precancers and cancers; notably, HPV-16+ group has a higher risk of HSIL squamous lesions and SCC while HPV-18/45+ group has a higher risk of AIS+ glandular lesions. In addition, the older patient group (>50 years) has a significantly higher risk of SCC. Therefore, HPV genotyping as well as patient age need to be considered in the clinical management of patient.

  • pathology department, hospital
  • papillomavirus infections
  • cytological techniques

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • QL and TZ are joint first authors.

  • SN and FZ are joint senior authors.

  • Handling editor Sarah Chiang.

  • Collaborators Not applicable.

  • Contributors All authors contributed to the study conception and design. FZ and SN conceived and designed the initial study. QL, TZ, LC, XZ, and XZ involved in drafting the manuscript and revising it critically for important intellectual content; FZ, SN, and WZ reviewed and edited the manuscript. All authors edited the manuscript and approved the final version. All researchers listed as authors are independent from the funders and all final decisions about the research were made without constraint by the investigators.

  • Funding This research was funded by National Nature Science Foundation of China (81901454).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.