title: Human papillomavirus (HPV) test and PAP smear as predictors of outcome in conservatively treated adenocarcinoma in situ (AIS) of the uterine cervix.
abstract: OBJECTIVE
  The present study assessed (i) the clinical outcome of patients with conservatively treated cervical adenocarcinoma in situ (AIS), (ii) the accuracy of diagnosing AIS by cytology, colposcopy and histology, as well as (iii) the performance of cervical cytology and HPV testing in detection of residual or recurrent disease after conservatively treated AIS.
  
  
  METHODS
  A series of 42 consecutive women (mean age 40.5 years; range 27-63 years) underwent conservative (cone) treatment of AIS and were prospectively followed up for a mean of 40 months (median 42 months), using colposcopy, PAP smear, biopsy and HPV testing (with hybrid capture II) repeated at 6-month intervals.
  
  
  RESULTS
  In their referral PAP test, only 42.9% of patients had atypical glandular cells (AGC) smear. Colposcopy was unsatisfactory in 54.8% cases and negative in 16.7%. Twenty four patients (57.1%) had AIS as a pure lesions and 18 combined with squamous cell lesion (four had invasive SCC). Persistent or recurrent disease was observed in 17 (40.4%) cases, 19% in patients with free margins, and 65% among those with involved margins on the first conization. In four patients, an adenocarcinoma (AdCa) stage IA1 was diagnosed during the follow-up. HPV testing significantly predicted disease persistence/clearance with OR 12.6 (95% CI 1.18-133.89), while the predictive power of PAP smear did not reach statistical significance at any of the follow-up visits. The combination of PAP smear and HPV testing gives SE of 90.0%, SP 50.0%, PPV 52.9% and NPV 88.9% at first follow-up, and 100% SE and 100% NPV at the second follow-up visit.
  
  
  CONCLUSIONS
  These results suggest that HR-HPV test in conjunction with cytology offers clear advantages over single cytology in monitoring the women conservatively treated for cervical AIS.
authors.affiliation: Department of Obstetrics and Gynecology, S. Orsola-Malpighi Hospital, Bologna, Italy. scosta@med.unibo.it <scosta@med.unibo.it>
authors.forename: Silvano
authors.initials: S
authors.lastname: Costa
authors.forename: Giovanni
authors.initials: G
authors.lastname: Negri
authors.forename: Mario
authors.initials: M
authors.lastname: Sideri
authors.forename: Donatella
authors.initials: D
authors.lastname: Santini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martinelli
authors.forename: Simona
authors.initials: S
authors.lastname: Venturoli
authors.forename: Carla
authors.initials: C
authors.lastname: Pelusi
authors.forename: Stina
authors.initials: S
authors.lastname: Syrjanen
authors.forename: Kari
authors.initials: K
authors.lastname: Syrjanen
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pelusi
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery / Q000821:virology*; D000328:Adult; D002278:Carcinoma in Situ; D019092:Conization; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000235:genetics; D030361:Papillomavirus Infections / Q000473:pathology* / Q000821:virology*; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery / Q000821:virology*; D014626:Vaginal Smears
chemical_list: D004279:DNA, Viral