Usefulness of human papillomavirus testing in the follow-up of patients with high-grade cervical intraepithelial neoplasia after conization.
OBJECTIVE
We aimed to define the adjunctive role of human papillomavirus (HPV) DNA testing in the follow-up of high-grade cervical intraepithelial neoplasia (CIN) after conization.


METHODS
We analyzed a consecutive series of 2,154 patients who received conization. Patients who had cone diagnosis of cervical cancer or CIN 1, a hysterectomy within 12 weeks after conization, and no follow-up data were excluded. The remaining 765 patients (monitored by Pap smears, colposcopy with or without high-risk HPV DNA testing) were analyzed.


RESULTS
Of the 765 patients, 279 had CIN at cone margin or endocervix (group A) while 486 were both margin- and endocervix-free (group B). The 3-year cumulative rate of residual/recurrent high-grade CIN was 10.3% (95% CI, 6.9-13.7). HPV follow-up status (P=.015), margin status (P=.001), and follow-up cervical cytology (P<.0001) were significant predictors for residual/recurrent high-grade CIN by multivariate analysis. Four high-grade CINs and 1 microinvasive carcinoma of group A were detected initially by HPV testing, while 48.3% (199/410) of those without recurrent/persistent high-grade CIN still had persistent HPV infection.


CONCLUSIONS
HPV DNA testing is useful in the follow-up and understanding of the natural history after conization for high-grade CIN.
Chao
Angel
A
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and University, Linkou Medical Center, Taoyuan, Taiwan.
Lin
Cheng-Tao
CT
Hsueh
Swei
S
Chou
Hung-Hsueh
HH
Chang
Ting-Chang
TC
Chen
Min-Yu
MY
Lai
Chyong-Huey
CH
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery / Q000821:virology; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery / Q000821:virology; D015331:Cohort Studies; D019092:Conization; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000601:surgery / Q000821:virology; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction / Q000592:standards; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013624:Taiwan / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000601:surgery / Q000821:virology; D014626:Vaginal Smears / Q000592:standards*; D002578:Uterine Cervical Dysplasia / Q000401:mortality* / Q000601:surgery / Q000821:virology
D004279:DNA, Viral