Human papilloma virus testing in patient follow-up post cone biopsy due to high-grade cervical intraepithelial neoplasia.
OBJECTIVE
We evaluated the contribution of the human papilloma virus (HPV) load in planning follow-up and management of women post cone biopsy for high-grade cervical intraepithelial neoplasia (CIN2-3).


METHODS
Ninety-six suitable women were followed-up by Pap smears: two consecutive abnormal smears dictated referral for colposcopy-directed biopsy. Before colposcopy, HPV tests determined high-risk HPV DNA type and load (Hybrid Capture System type I). Patients histologically diagnosed with CIN1 or CIN2-3 underwent repeat conization or hysterectomy for residual disease. HPV load was compared to cytology for the detection of residual disease.


RESULTS
At follow-up, 20/89 (22.4%) studied women had positive cytology reports of either low- (n = 11) or high-grade (n = 9) squamous intraepithelial lesion (SIL). Colposcopic biopsies diagnosed 9 CIN1 and 8 CIN2-3 cases. Residual disease was corroborated in 16/17 (94.1%) women and the status was readjusted based on cone biopsy/hysterectomy: CIN2-3 in 9 and CIN1 in 7. The positive prediction values for CIN2-3 residual disease with high-grade SIL, CIN2-3 on colposcopic punch biopsy, and high HPV load were 89, 100, and 100%, respectively. For CIN1 residual disease with low-grade SIL, CIN1 on colposcopic punch biopsy, and low and borderline HPV load, they were 54.5, 77.7, and 100%. The HPV load was a more accurate predictor for CIN1 or CIN2-3 on the cervical specimen in cases with low-grade SIL or CIN1 on colposcopic biopsy.


CONCLUSIONS
Evaluating HPV loads after a positive cytology report may assist in triaging women post conization biopsy for CIN2-3 to appropriate treatment. Its high positive predictive value, specificity, and sensitivity for CIN1 and CIN2-3 and supplementary information could be especially pertinent for clinical management of low-grade SIL cases.
Almog
Benny
B
Cervical Pathology Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 64239, Tel Aviv, Israel.
Gamzu
Ronni
R
Kuperminc
Michael J
MJ
Levin
Ishai
I
Fainaru
Ofer
O
Niv
Jakov
J
Bar-Am
Amiram
A
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D019092:Conization / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000150:complications / Q000821:virology*; D011446:Prospective Studies; D014412:Tumor Virus Infections / Q000150:complications / Q000821:virology*; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery / Q000821:virology*; D019562:Viral Load; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000601:surgery / Q000821:virology*