title: Predictors of absence of cervical intraepithelial neoplasia in the conization specimen.
abstract: OBJECTIVE
  Over 10% of women who undergo conization for cervical intraepithelial neoplasia (CIN) show no lesion in the surgical specimen. We aimed to determine whether these patients can be identified before conization using clinical, virological and/or cyto-histological characteristics, to avoid unnecessary treatment.
  
  
  METHODS
  Of 687 women with CIN treated by conization in the Hospital Clinic of Barcelona between 2008 and 2011, all patients (n=110, 16%) showing no lesion in the surgical specimen were included as the study group. The control group included a series of randomly selected women with CIN in the cone specimen (n=220). Pre-conization clinical characteristics as well as high-risk human papillomavirus (hr-HPV) status determined by Hybrid Capture 2 were analyzed as possible predictors of absence of lesion.
  
  
  RESULTS
  A negative pre-conization hr-HPV test or a low viral load (<10 relative light units) significantly increased the probability of absence of CIN in the conization specimen (75.0%, and 52% respectively) compared with patients with a high viral load (26.7%, p<0.001). This association was confirmed in the multivariate analysis (p<0.001). The risk of developing persistent/recurrent disease after treatment was significantly lower in patients with negative hr-HPV test or a low viral load (16.1% CIN1, 0% CIN2-3), than in patients with a high viral load (27.6% CIN1, 4.1% CIN2-3, p=0.031).
  
  
  CONCLUSIONS
  Women with negative pre-conization hr-HPV test results or a low viral load have a high probability of having no lesion in the conization specimen. These patients should be excluded from immediate surgical excision and considered for follow-up.
authors.affiliation: Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clínic-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain.
authors.forename: Agata
authors.initials: A
authors.lastname: Rodriguez-Manfredi
authors.forename: Immaculada
authors.initials: I
authors.lastname: Alonso
authors.forename: Marta
authors.initials: M
authors.lastname: del Pino
authors.forename: Pere
authors.initials: P
authors.lastname: Fusté
authors.forename: Aureli
authors.initials: A
authors.lastname: Torné
authors.forename: Jaume
authors.initials: J
authors.lastname: Ordi
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D019092:Conization / Q000379:methods; D004598:Electrosurgery / Q000379:methods; D005260:Female; D006801:Humans; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000473:pathology / Q000821:virology; D011237:Predictive Value of Tests; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery / Q000821:virology; D019562:Viral Load; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000601:surgery / Q000821:virology