Role of HPV testing in the follow-up of women treated for cervical dysplasia.
OBJECTIVE
The aim of study was to investigate factors predicting persistence or relapse of disease after cervical conisation for high-grade squamous intraepithelial lesions (CIN 2 or 3).


METHODS
The study involved 78 women with high-grade squamous intraepithelial lesions, conservatively treated with loop electroexcision procedure for cervical conisation and subsequent with CO(2) laser-vaporisation of the cervical bed. Histological specimens were totally included and examined by an experienced pathologist. To evaluate the efficacy of treatment, the patients were examined with colposcopy and Pap smear 4 months after surgery and with PCR to search for and genotyping of HPV, 10 months after treatment.


RESULTS
During the post-treatment follow-up, the cytologic examination showed persistent/relapsing disease in six patients (7.6%). In only 1 case, the deep margin of the cone was considered positive for CIN (16%).Ten months after treatment, viral typing revealed the persistence of high-risk HPV in all of these patients. Conversely, the viral follow-up of the other 72 patients without persisting/relapsing disease after treatment disclosed low-risk HPV genotypes in 6 cases, high-risk HPV in 2 cases (2.7%), whereas 7 cases had positive margins for CIN (9.7%). The risk of persistence and relapse of CIN in the group with positive margins was not statistically significant (P = 0.87), whereas it was in the group with HR-HPV positive (P = 0.000048).


CONCLUSIONS
HPV testing is the most sensitive mean of identifying persistence or relapse early and is therefore capable of optimising follow-up after the treatment of high-grade CIN.
Ribaldone
Raffaella
R
Obstetric and Gynecological Unit, Maggiore Hospital and University of Eastern Piedmont, Novara, Italy.
Boldorini
Renzo
R
Capuano
Andrea
A
Arrigoni
Silvia
S
Di Oto
Alessia
A
Surico
Nicola
N
D000328:Adult; D000368:Aged; D019092:Conization; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000821:virology*; D018307:Neoplasms, Squamous Cell / Q000473:pathology / Q000601:surgery* / Q000821:virology; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery* / Q000821:virology; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery* / Q000821:virology; D014626:Vaginal Smears; D055815:Young Adult