title: Intraoperative post-conisation human papillomavirus testing for early detection of treatment failure in patients with cervical intraepithelial neoplasia: a pilot study.
abstract: OBJECTIVE
  To evaluate the feasibility and utility of intraoperative post-conisation human papillomavirus (IOP-HPV) testing and cytology to detect treatment failure in patients with cervical intraepithelial neoplasia grades 2-3 (CIN2-3).
  
  
  METHODS
  Prospective observational pilot study.
  
  
  METHODS
  Barcelona, Spain.
  
  
  METHODS
  A cohort of 132 women treated for CIN2-3 by loop electrosurgical conisation.
  
  
  METHODS
  An endocervical sample was obtained intraoperatively with a cytobrush from the cervix remaining after the conisation. The material was kept in PreservCyt medium and processed for Hybrid Capture 2 and cytology. Patients were followed-up for 24 months. The performance of IOP-HPV testing and IOP cytology was compared with conventional indicators of recurrence (cone margin, endocervical curettage, and HPV testing and cytology at 6 months).
  
  
  METHODS
  Treatment failure (i.e. recurrent CIN2-3 during follow-up).
  
  
  RESULTS
  Treatment failure was identified in 12 women (9.1%). IOP-HPV testing for sensitivity, specificity, and positive and negative predictive values for treatment failure were 91.7, 78.3, 62.2, and 96.0%, respectively, which are similar to the figures for conventional HPV testing at 6 months (91.7, 76.0, 64.0, and 95.1%, respectively), and are better than the values of other conventional predictive factors (cone margin, endocervical curettage, and cytology intraoperative at 6 months). IOP-HPV was strongly associated with treatment failure in the multivariate analysis (OR 15.40, 95% CI 1.58-150.42).
  
  
  CONCLUSIONS
  IOP-HPV testing is feasible, and accurately predicts treatment failure in patients with CIN2-3. This new approach may allow an early identification of patients with treatment failure, thereby facilitating the scheduling of an attenuated follow-up for negative patients who are at very low risk of persistent disease.
authors.affiliation: Institut Clinic of Gynaecology, Obstetrics and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Faculty of Medicine, University of Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Torné
authors.forename: P
authors.initials: P
authors.lastname: Fusté
authors.forename: L
authors.initials: L
authors.lastname: Rodríguez-Carunchio
authors.forename: I
authors.initials: I
authors.lastname: Alonso
authors.forename: M
authors.initials: M
authors.lastname: del Pino
authors.forename: R
authors.initials: R
authors.lastname: Nonell
authors.forename: M
authors.initials: M
authors.lastname: Cardona
authors.forename: A
authors.initials: A
authors.lastname: Rodríguez
authors.forename: P
authors.initials: P
authors.lastname: Castillo
authors.forename: J
authors.initials: J
authors.lastname: Pahisa
authors.forename: J
authors.initials: J
authors.lastname: Balasch
authors.forename: J
authors.initials: J
authors.lastname: Ramírez
authors.forename: J
authors.initials: J
authors.lastname: Ordi
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000601:surgery*; D003127:Colposcopy / Q000379:methods; D019092:Conization / Q000379:methods*; D055088:Early Detection of Cancer / Q000379:methods; D004598:Electrosurgery / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D018365:Neoplasm, Residual / Q000175:diagnosis; D030361:Papillomavirus Infections / Q000175:diagnosis*; D010865:Pilot Projects; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D017211:Treatment Failure; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery* / Q000821:virology