title: The predictive value of human papillomavirus testing for the outcome of patients conservatively treated for stage IA squamous cell cervical carcinoma.
abstract: BACKGROUND
  Although it is hypothesised that human papillomavirus (HPV) testing may have a role in surveillance of patients conservatively treated for stage IA squamous cell cervical carcinoma, research on this topic has been minimal.
  
  
  OBJECTIVE
  To determine: (1) the changes in HPV test result from treatment onward; (2) the time to viral clearance; and (3) the negative predictive value (NPV) and positive predictive value (PPV) of HPV test result for the detection of CIN2 or worse (CIN2+) during follow-up.
  
  
  METHODS
  In a multicentre retrospective follow-up study of a consecutive series (1997-2009) of 91 patients, longitudinal outcome measures were estimated as cumulative probabilities using the Kaplan-Meier method.
  
  
  RESULTS
  For patients testing HPV-positive at the first follow-up visit (n=44), the probability of change to negative rose from 0 to 0.78 between 7 and 21 months after treatment. For HPV-negative patients (n=47), the probability of change to positive rose to 0.13 between 9 and 26 months. After a median follow-up of 50 months (range, 2-80), the NPV for CIN2+ was 1.00. The PPV was 0.60 (95% confidence interval, 0.43-0.77) after 26 months. The median time to detection was 5 months.
  
  
  CONCLUSIONS
  If adequately confirmed, these findings would indicate that HPV testing is capable to identify the patients who have had their lesions fully removed, and would make it possible to focus follow-up efforts on a subset of patients at high risk of residual or progressive disease.
authors: Department of Obstetrics and Gynaecology, St. Orsola-Malpighi University Hospital, Bologna, Italy.
authors: Silvano
authors: S
authors: Costa
authors: Preventive Gynaecology Unit, European Institute of Oncology, Milano, Italy.
authors: Mario
authors: M
authors: Sideri
authors: Department of Pathology, Central Hospital of Bolzano, Bolzano, Italy.
authors: Giovanni
authors: G
authors: Negri
authors: Department of Haematology, Oncology and Laboratory Medicine, Section of Microbiology, St. Orsola-Malpighi University Hospital, Bologna, Italy.
authors: Simona
authors: S
authors: Venturoli
authors: Department of Pathology, St. Orsola-Malpighi University Hospital, Bologna, Italy.
authors: Donatella
authors: D
authors: Santini
authors: Cytology Unit, Department of Pathology, European Institute of Oncology, Milano, Italy.
authors: Chiara
authors: C
authors: Casadio
authors: Division of Laboratory Medicine, European Institute of Oncology, Milano, Italy.
authors: Maria T
authors: MT
authors: Sandri
authors: Romagna Cancer Registry, Romagna Cancer Institute (IRST), Meldola, Forlì, Italy. Electronic address: lauro.bucchi@irst.emr.it.
authors: Lauro
authors: L
authors: Bucchi
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D060005:Genotyping Techniques; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics*; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis* / Q000821:virology*; D016133:Polymerase Chain Reaction / Q000379:methods / Q000592:standards; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy
keywords: Cervical cancer; Cervical intraepithelial neoplasia; Follow-up; HPV testing; Negative predictive value