title: Pre- and post-conization high-risk HPV testing predicts residual/recurrent disease in patients treated for CIN 2-3.
abstract: OBJECTIVE
  To evaluate whether high-risk human papillomavirus (HR-HPV) detection and viral load prior to treatment and status of cone margins can predict residual/recurrent disease as well as the ability of current diagnostic tools to identify residual/recurrent disease during follow-up of high-grade cervical intraepithelial neoplasia (CIN) treated by conization using loop electrosurgical procedure (LEEP).
  
  
  METHODS
  Two hundred and three women (mean age 38.6 +/- 9.7; range 22-83) with CIN2-3 treated by LEEP conization and confirmed in the surgical specimen, attending follow-up visits were included. Age, HR-HPV detection and viral load determined by HybridCapture 2, and cone margins were evaluated as possible predictors of residual/recurrent disease. Value of single and repeated cytology as well as HR-HPV detection and viral load during follow-up were analyzed as screening tools of recurrence.
  
  
  RESULTS
  Residual/recurrent disease was demonstrated by colposcopy guided biopsy in 36 patients (17.7%). High HR-HPV load (>1000 RLU) prior to LEEP and positive cone margins were significantly associated with higher risk of recurrence (31.8% vs. 9.4%, P = 0.005; and 36.4% vs. 11.9%, P < 0.001 respectively). HR-HPV detection at 6-12 m after LEEP showed higher sensitivity than a single or repeated cytology (97.2% vs. 83.3% and 94.4% respectively) although it showed less specificity (81.4% vs. 92.2% and 82.6%). The combination of HR-HPV detection and the first cytology during follow-up detected all patients with residual/recurrent disease (sensitivity 100%, negative predictive value 100%) with an acceptable specificity (76.6%).
  
  
  CONCLUSIONS
  The inclusion of HR-HPV testing with cytology in follow-up of patients treated for CIN2-3 would allow for fewer post-treatment visits and avoid unnecessary cytologies. High HR-HPV load prior to LEEP or positive margins should be considered as risk factors for developing residual/recurrent disease.
authors.affiliation: Department of Obstetrics and Gynecology, IDIBAPS-Hospital Clínic, University of Barcelona School of Medicine, Barcelona, Spain.
authors.forename: Immaculada
authors.initials: I
authors.lastname: Alonso
authors.forename: Aureli
authors.initials: A
authors.lastname: Torné
authors.forename: Luis M
authors.initials: LM
authors.lastname: Puig-Tintoré
authors.forename: Roser
authors.initials: R
authors.lastname: Esteve
authors.forename: Llorenç
authors.initials: L
authors.lastname: Quinto
authors.forename: Elias
authors.initials: E
authors.lastname: Campo
authors.forename: Jaume
authors.initials: J
authors.lastname: Pahisa
authors.forename: Jaume
authors.initials: J
authors.lastname: Ordi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D052685:Alphapapillomavirus / Q000254:growth & development*; D019092:Conization / Q000379:methods; D004598:Electrosurgery / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000821:virology*; D018365:Neoplasm, Residual; D030361:Papillomavirus Infections / Q000150:complications / Q000821:virology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000601:surgery* / Q000821:virology*; D019562:Viral Load; D002578:Uterine Cervical Dysplasia / Q000601:surgery* / Q000821:virology*