Persistent HPV infection after conization in patients with negative margins.
OBJECTIVE
To investigate the rate of clearance of high-risk HPV after conization with negative margins and to identify the factors that may predict high-risk HPV clearance/persistence after conization with negative margins.


METHODS
We performed a retrospective review of 69 patients (mean age 39.5 years, range 25-60 years) with histologically verified CIN 2 or CIN 3 who underwent electroknife conization with negative margins between March 2002 and December 2003. High-risk HPV testing was performed on cervical cytology prior to and 6 months after conization. Hybrid Capture II testing was used to detect HPV DNA.


RESULTS
High-risk HPVs were detected in the primary cervical lesions of 67 of 69 patients (97.1%) prior to conization. Follow-up at 6 months revealed that high-risk HPVs were eradicated by conization in 82.1%. Univariate analysis showed that persistent HPV infection after conization with negative margins was more likely to occur when the pretreatment viral load was high (RLU/PC > 500) (P = 0.005). HPV infection after conization with negative margins was persistent in 43.8% (7/16) of patients with high viral load (RLU/PC > 500) and in 9.8% (5/51) of patients with low viral load (RLU/PC < or = 500). Multiple regression analysis showed that high viral load (RLU/PC > 500) was the only significant independent predictor of HPV persistence (P = 0.0027).


CONCLUSIONS
High-risk HPV infections were effectively eliminated by conization with negative margins in most cases. Because high viral loads are significantly associated with high-risk HPV persistence after conization with negative margins, patients with high viral loads prior to conization should be closely followed.
Song
Seung-Hun
SH
Department of Obstetrics and Gynecology, Korea University School of Medicine, Guro Hospital, Guro-Dong, Guro-Gu, Seoul, 152-703 RO, South Korea.
Lee
Jae-Kwan
JK
Oh
Min-Jeong
MJ
Hur
Jun-Young
JY
Na
Jung-Yeol
JY
Park
Yong-Kyun
YK
Saw
Ho-Suk
HS
D000328:Adult; D019092:Conization; D004279:DNA, Viral / Q000378:metabolism; D005260:Female; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics / Q000254:growth & development*; D030361:Papillomavirus Infections / Q000821:virology*; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery* / Q000821:virology*; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery* / Q000821:virology*
D004279:DNA, Viral