title: Performance of HPV DNA testing in the follow-up after treatment of high-grade cervical lesions, adenocarcinoma in situ (AIS) and microinvasive carcinoma.
abstract: BACKGROUND
  Over the last two decades it has become clear that distinct types of human papillomavirus (HPV), the so-called high-risk types (hrHPV), are the major cause of cervical cancer. The hrHPV-DNA testing has shown excellent performance in several clinical applications from screening to the follow-up of conservatively treated patients.
  
  
  METHODS
  We conducted a systematic review of the recent literature on the performance of HPV DNA testing in follow-up after treatment of high-grade cervical lesions, adenocarcinoma in situ, and microinvasive carcinoma compared to Pap smear cytology.
  
  
  RESULTS
  Observational studies have demonstrated that the high risk hrHPV-DNA test is significantly more sensitive (95%) compared to follow-up cytology(70%) in detecting post-treatment squamous intraepithelial high-grade lesions. Moreover, in patients treated conservatively for cervical adenocarcinoma in situ, the hrHPV-DNA test is the most significant independent predictor of recurrent disease or progression to invasive cancer, and the combination of viral DNA testing and cytology reaches 90% sensitivity in detecting persistent lesions at the first follow-up visit and 100% at the second follow-up visit. The cause of microinvasive squamous cervical carcinoma is increasingly treated with conservative therapies in order to preserve fertility, and an effective strategy allowing early detection of residual or progressive disease has become more and more important in post-treatment follow-up. Primary results seem to indicate that the median time for viral clearance is relatively longer compared with patients treated for CIN and suggest a prolonged surveillance for these patients. However, the potential clinical value of HPV-DNA testing in this clinical setting needs to be confirmed by further observations.
  
  
  CONCLUSIONS
  The excellent sensitivity, negative predictive value, and optimal reproducibility of the hrHPV DNA testing, currently is considered a powerful tool in the clinicians' hands to better manage post-treatment follow-up either in cervical squamous lesion or in situ adenocarcinoma.
authors.affiliation: Obstetrics & Gynaecology Unit, Policlinico S Orsola-Malpighi University Hospital, Bologna, Italy Present address: MF Toniolo Hospital, via Toscana, 42, Bologna 40138, Italy ; The Italian HPV Study Group (IHSG).
authors.forename: Silvano
authors.initials: S
authors.lastname: Costa
authors.affiliation: Unit of Microbiology, Department of Diagnostic Medicine and Prevention, S Orsola-Malpighi Hospital, University of Bologna, Bologna 40138, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Venturoli
authors.affiliation: Department of Obstetrics & Gynaecology, School of Medicine, Vita-Salute San Raffaele University, Milano 20132, Italy ; The Italian HPV Study Group (IHSG).
authors.forename: Massimo
authors.initials: M
authors.lastname: Origoni
authors.affiliation: Preventive Gynaecology Unit, European Institute of Oncology, Milano 20141, Italy ; The Italian HPV Study Group (IHSG).
authors.forename: Mario
authors.initials: M
authors.lastname: Preti
authors.affiliation: HPV Unit, Gynaecologic Oncology, Regina Elena National Cancer Institute of Rome, Rome 00144, Italy ; The Italian HPV Study Group (IHSG).
authors.forename: Luciano
authors.initials: L
authors.lastname: Mariani
authors.affiliation: National Institute on Cancer Research (IST), Genova 16132, Italy ; The Italian HPV Study Group (IHSG).
authors.forename: Paolo
authors.initials: P
authors.lastname: Cristoforoni
authors.affiliation: Preventive Gynaecology Unit, European Institute of Oncology, Milano 20141, Italy ; The Italian HPV Study Group (IHSG).
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Sandri
keywords: CIN recurrence; CIN2+ lesion; HPV-testing; adenocarcinioma in situ; follow-up; genotyping; microinvasive squamous carcinoma