Follow-up after treatment of cervical intraepithelial neoplasia by human papillomavirus genotyping.
OBJECTIVE
To assess the use of human papillomavirus genotyping in cervical intraepithelial neoplasia posttreatment follow-up.


METHODS
Prospective observational study. Ninety women underwent cytologic testing and human papillomavirus genotyping at the follow-up visit after conization. Cones were retrospectively genotyped. A second cytologic follow-up was performed.


RESULTS
Margin status and presence of cervical intraepithelial neoplasia 3+ in the cone were poor predictors of treatment outcome (sensitivity, < 50%; diagnostic odds ratio, <or= 2.5). Presence of high-/intermediate-risk human papillomavirus types predicted 100% of residual high-grade squamous intraepithelial lesion/cervical intraepithelial 2+ at a specificity of 73%. Testing only 13 high-risk types showed equal sensitivity but higher specificity (86%; P < .01). Persistent high-risk human papillomavirus infection (13 types) detected high-grade residual disease with a sensitivity of 60% at a very high specificity (95%), resulting in a positive predictive value of 43%, which exceeded the positive predictive values of all other criteria.


CONCLUSIONS
Testing for high-risk human papillomavirus identified all recurrent/residual high-grade cervical intraepithelial neoplasia. Focusing on women with persistent human papillomavirus types through genotyping substantially increased positive predictive value but at a loss in sensitivity.
Department for Clinical Science, Division of Obstetrics and Gynecology, Karolinska University Hospital-Huddinge, Karolinska Institute, Stockholm, Sweden.
Sophia
S
Brismar
Bo
B
Johansson
Malin
M
Borjesson
Marc
M
Arbyn
Sonia
S
Andersson
D000328:Adult; D002584:Cervix Uteri / Q000473:pathology / Q000821:virology; D019092:Conization; D003266:Continuity of Patient Care; D005260:Female; D005838:Genotype; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D027383:Papillomaviridae / Q000235:genetics*; D030361:Papillomavirus Infections / Q000150:complications* / Q000601:surgery; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012680:Sensitivity and Specificity; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery* / Q000821:virology*