The significance of HPV in the follow-up period after treatment for CIN.
OBJECTIVE
High-risk anogenital human papillomavirus (HPV) infections are causally related to cervical cancer. Successful treatment of cervical intraepithelial neoplasia (CIN) results in complete eradication of HPV in most cases. There is an increasing interest regarding the role of HPV testing in the follow-up period after treatment for CIN.


METHODS
This retrospective study includes 107 women who underwent conization for histologically verified CIN. All of them had HPV testing pre- and postoperatively. HPV testing was carried out using a hybrid capture assay (HC2). The mean follow-up period was 21.4 months (range 2-76 months). The data were analyzed with respect to success of conization, HPV persistence/recurrence and CIN recurrence. Sensitivity, specificity and negative predictive value (NPV) of HPV testing were assessed and compared to the cytological results.


RESULTS
Preoperatively, 97 of 107 women were HPV positive. Ninety-seven conizations showed negative resection margins with 86 women becoming HPV negative. In the following months, nine of these HPV negative women became HPV positive again. Out of ten conizations with positive resection margins, six women became HPV negative. Recurrent CIN 2/3 lesions were observed in 11 women, nine of whom had persistent positive HPV testing throughout the entire study period. Regarding CIN recurrence HPV testing showed a sensitivity of 93%, a specificity of 85% and a NPV of 99%.


CONCLUSIONS
The sensitivity of HPV testing concerning persistent or recurrent CIN as well as the NPV are high. The present data suggest that HPV testing should be integrated in a follow-up algorithm after treatment for CIN by conization.
Gallwas
J
J
Department of Obstetrics and Gynecology, University of Munich, Munich, Germany.
Ditsch
N
N
Hillemanns
P
P
Friese
K
K
Thaler
C
C
Dannecker
C
C
D000328:Adult; D000368:Aged; D019092:Conization; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques; D009364:Neoplasm Recurrence, Local; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012008:Recurrence; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000601:surgery / Q000821:virology*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000601:surgery / Q000821:virology*
D004279:DNA, Viral