title: PCR detection rates of high risk human papillomavirus DNA in paired self-collected urine and cervical scrapes after laser CO2 conization for high-grade cervical intraepithelial neoplasia.
abstract: OBJECTIVE
  To compare the PCR detection rates of high risk human papillomavirus DNA in self-collected urine and cervical scrapes during follow-up of patients treated for HG-CIN by laser CO2 conization.
  
  
  METHODS
  52 women who submitted to laser conization for HG-CIN were enrolled into this prospective follow-up study receiving liquid-based cytology and HR-HPV testing by PCR assay on self-collected urine and cervical scrapes before and at 3, 6 and 12 months after treatment. Diagnostic accuracy and predictive values for treatment failure were evaluated for both urinary and cervical HPV testing and follow-up cytology.
  
  
  RESULTS
  3 cases (5.8%) of recurrent HG-CIN occurred during follow-up. Positive margins and HR-HPV persistence resulted to significant risk factors for recurrence (p=0.01). The overall concordance on HR-HPV detection between paired urine and cervical samples was 96.6% and discord trend between agreement rates during follow-up were excluded by overall fixed-effect index (OR 1.03; 95% CI 0.62-1.70). No difference was observed comparing the three- and six-month cumulative sensitivity and NPV for recurrent disease of urinary and cervical HPV detections, with an increase of 5.6% in specificity associated with urinary testing.
  
  
  CONCLUSIONS
  PCR detection of HR-HPV in paired urine and cervical samples during follow-up revealed an excellent concordance, suggesting a potential equivalent role of the two methods within post-treatment follow-up. In our experience HPV testing on self-collected urine was more sensitive than cytology and more specific than cervical HPV detection to predict treatment failure. Larger studies are needed to definitively establish the role of urine-based HPV testing during follow-up.
authors.affiliation: Department of Gynecology, Perinatology and Human Reproduction, University of Florence, Policlinico di Careggi, Viale Morgagni 85, 50134 Florence, Italy. maxfambrini@libero.it
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Fambrini
authors.forename: Carlo
authors.initials: C
authors.lastname: Penna
authors.forename: Annalisa
authors.initials: A
authors.lastname: Pieralli
authors.forename: Cecilia
authors.initials: C
authors.lastname: Bussani
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Fallani
authors.forename: Karin L
authors.initials: KL
authors.lastname: Andersson
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Scarselli
authors.forename: Mauro
authors.initials: M
authors.lastname: Marchionni
mesh_terms: D000293:Adolescent; D000328:Adult; D019092:Conization; D004279:DNA, Viral / Q000032:analysis* / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000821:virology; D027383:Papillomaviridae / Q000235:genetics* / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000473:pathology / Q000652:urine* / Q000821:virology*; D016133:Polymerase Chain Reaction / Q000379:methods; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery / Q000652:urine* / Q000821:virology*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery / Q000821:virology
chemical_list: D004279:DNA, Viral