High-risk human papillomavirus testing for monitoring patients treated for high-grade cervical intraepithelial neoplasia.
OBJECTIVE
The aim of the present study was to examine the accuracy of high-risk human papillomavirus (HR-HPV) DNA detection as a predictor of residual or recurrent cervical intraepithelial neoplasia (CIN) after treatment of high-grade CIN.


METHODS
Ninety-five women treated by conization and loop electrosurgical excision procedure (LEEP) for high-grade CIN were followed-up with HR-HPV DNA testing (Hybrid Capture II test, Digene Diagnostics, Gaithersburg, MD, USA) and cytology at 3, 6, 12, 18 and 24 months after treatment. The outcome of our study was to detect the presence of CIN using colposcopy-directed biopsy within 24 months after treatment.


RESULTS
Women with recurrent or residual disease did not differ from women who were cured within clinicopathologic parameters at treatment. Pre-treatment HR-HPV testing was positive in all cases. In the recurrent pre-treatment group HR-HPV loads were significantly higher than in the group with no recurrence (1065.5 +/- 852.3 vs 527.7 +/- 669.6, P = 0.003). Residual or recurrent disease was identified in 17 patients (17.9%) during a 24-month period. A Pap smear significantly predicted disease recurrence at the first follow-up visit only. At the 6-month visit, HR-HPV testing showed 100% sensitivity and negative predictive value (NPV). When both a Pap smear and a HR-HPV test were used together, 82% sensitivity, 76% specificity and 95% NPV was noted. Performance of resection margins (odds ratio (OR) 9.8; 95% confidence interval (CI), 3.0-32.7) and post-treatment HR-HPV load >100 RLU (OR 9.3; 95% CI, 2.2-38.2) were also significant.


CONCLUSIONS
HR-HPV testing in conjunction with Pap smear offers clear advantages over single cytology when monitoring women treated for high-grade CIN.
Jeong
Nan Hee
NH
Department of Obstetrics and Gynecology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea.
Lee
Nak Woo
NW
Kim
Hai Joong
HJ
Kim
Tak
T
Lee
Kyu Wan
KW
D000328:Adult; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000302:isolation & purification*; D011446:Prospective Studies; D012306:Risk; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000601:surgery / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000601:surgery / Q000821:virology
D004279:DNA, Viral