title: Role of human papillomavirus testing and cytology in follow-up after conization.
abstract: OBJECTIVE
  Adequate follow-up of women who have undergone conization for high-grade cervical lesions is crucial in cervical cancer screening programs. We evaluated the performance of testing for high-risk human papillomavirus (HPV) types, cytology alone, and combined testing in predicting cervical intraepithelial neoplasia grade 2 or worse (CIN2+) after conization.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Denmark.
  
  
  METHODS
  667 women attending for conization.
  
  
  METHODS
  Cervical specimens were collected during 2002-2006 at first visit after conization for cytological examination and Hybrid Capture 2 detection of high-risk HPV. The women were passively followed until 2 years after first follow-up visit by linkage to the nationwide Pathology Data Bank.
  
  
  RESULTS
  At first visit after conization (median time, 3.4 months), 20.4% were HPV-positive and 17.2% had atypical squamous intraepithelial lesions or more severe cytology (ASCUS+). The 2-year incidence of CIN2+ after conization was 3.6%. Sensitivity for detection of CIN2+ after conization was 81.0% [95% confidence interval (CI) 58.1-94.6] for positive cytology (ASCUS+ threshold) and 95.2% (95% CI 76.2-99.9) for HPV testing and for combined testing. Specificity of ASCUS+ cytology (85.2%; 95% CI 82.0-88.0) was higher than that of HPV testing (82.4%; 95% CI 79.0-85.4) and markedly higher than that of combined testing (73.2%; 95% CI 69.3-76.8). The margin status had no significant added value.
  
  
  CONCLUSIONS
  Testing for high-risk HPV three to four months after conization is more sensitive than ASCUS+ cytology for identifying women at risk for relapse of CIN2+ within 2 years. Further studies are needed to evaluate whether HPV testing could be a stand-alone test in follow up after conization.
authors: Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
authors: Camilla F
authors: CF
authors: Gosvig
authors: Lene D
authors: LD
authors: Huusom
authors: Isabelle
authors: I
authors: Deltour
authors: Klaus K
authors: KK
authors: Andersen
authors: Anne Katrine
authors: AK
authors: Duun-Henriksen
authors: Ellen Merete
authors: EM
authors: Madsen
authors: Lone K
authors: LK
authors: Petersen
authors: Lisbeth
authors: L
authors: Elving
authors: Lars
authors: L
authors: Schouenbourg
authors: Angelika
authors: A
authors: Iftner
authors: Edith
authors: E
authors: Svare
authors: Thomas
authors: T
authors: Iftner
authors: Susanne K
authors: SK
authors: Kjaer
mesh_terms: D000328:Adult; D019092:Conization; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery* / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery* / Q000821:virology
keywords: Cervix; HPV; conization; relapse; sensitivity; specificity