title: Follow-up by combined cytology and human papillomavirus testing for patients post-cone biopsy: results of a long-term follow-up.
abstract: OBJECTIVE
  The goal of this study was to evaluate the clinical implications of integrating human papillomavirus (HPV) testing into a long-term follow-up and management protocol for women postconization for high-grade cervical intraepithelial neoplasia (CIN2-3).
  
  
  METHODS
  Sixty-seven women were followed-up by Pap smears and HPV type and load testing (mean follow-up, 63 months; range, 50-72). Patients with persistent abnormal cytology on two consecutive smears and those with positive HPV test results (whatever their cytologic findings) were referred for colposcopy-directed biopsy. Patients histologically diagnosed with CIN2-3 and those with high-load HPV (whatever their histologic findings) underwent repeat conization or hysterectomy for residual disease.
  
  
  RESULTS
  At follow-up, 29 (43.2%) women had positive cytology or positive HPV results and were referred for colposcopy. Eleven (37.9%) had high-grade cervical intraepithelial neoplasia or high-load HPV results and were further treated by reconization/hysterectomy. The respective positive predictive values of high-load HPV and low-grade squamous intraepithelial lesions were 100 and 60% for any CIN and 90 and 15% for CIN2-3. Only five of nine cases with a final diagnosis of CIN2-3 were originally identified by cytology: the other four were detected only by parallel evaluation by HPV testing. High-load HPV results with normal cytology or low-grade lesions harbored an 80% risk for CIN2-3.
  
  
  CONCLUSIONS
  Adding HPV load assessment to the follow-up protocol of women postconization due to CIN2-3 lesions could help detect high-grade residual disease among low-grade lesions and normal cytology cases while concomitantly and safely bestowing the advantage of lowering the rates of colposcopic referrals and surgical procedures.
authors.affiliation: Cervical Pathology Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 64239. eshkol@tasmc.health.gov.il
authors.forename: Amiram
authors.initials: A
authors.lastname: Bar-Am
authors.forename: Ronni
authors.initials: R
authors.lastname: Gamzu
authors.forename: Ishai
authors.initials: I
authors.lastname: Levin
authors.forename: Ofer
authors.initials: O
authors.lastname: Fainaru
authors.forename: Jakov
authors.initials: J
authors.lastname: Niv
authors.forename: Benny
authors.initials: B
authors.lastname: Almog
mesh_terms: D000293:Adolescent; D000328:Adult; D019092:Conization; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000150:complications / Q000821:virology*; 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*