title: HPV testing in the context of post-treatment follow up (test of cure).
abstract: BACKGROUND
  Women treated for cervical lesions are at higher risk of subsequent disease compared to the general population. Consequently, post treatment surveillance strategies are required to ensure the success of treatment, so called "test of cure". The high sensitivity and negative predictive value of HPV assays can enhance post-treatment strategies.
  
  
  OBJECTIVE
  To provide an overview of the current data on test of cure strategies with a particular focus on HPV testing and to identify knowledge gaps and areas for further research.
  
  
  RESULTS
  HPV testing is sensitive for the detection of residual or recurrent disease post treatment for CIN2+ and is more sensitive than cytology alone. Co-testing increases sensitivity, marginally and there is a lack of consensus regarding the efficiency and safety to release negative women. Most test of cure studies have applied HPV DNA tests and post treatment positivity rates vary widely depending on assay and potentially, treatment type.
  
  
  CONCLUSIONS
  Globally, an increasing number of test of cure algorithms now incorporate HPV testing although there is heterogeneity of practice with respect to assay, number of post treatment tests, testing intervals, follow up time. While type specific persistence identified through genotyping may identify those at greater risk of disease there is no consensus as to how this may be applied, clinically. Data on HPV testing in women treated for glandular lesions would be welcome as would the performance of different HPV assays and associated biomarkers in this context.
authors.affiliation: Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, NHS Lothian, Scotland, UK. Electronic address: Kate.Cuschieri@luht.scot.nhs.uk.
authors.forename: Kate
authors.initials: K
authors.lastname: Cuschieri
authors.affiliation: HPV Research Group, Division of Pathology, University of Edinburgh, Scotland, UK.
authors.forename: Ramya
authors.initials: R
authors.lastname: Bhatia
authors.affiliation: Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, NHS Grampian, Scotland, UK.
authors.forename: Margaret
authors.initials: M
authors.lastname: Cruickshank
authors.affiliation: Department of Obstetrics and Gynecology, Hannover Medical School, University of Hannover, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Hillemanns
authors.affiliation: Unit of Cancer Epidemiology & Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Arbyn
mesh_terms: D054316:Biomarkers, Pharmacological / Q000378:metabolism; D004279:DNA, Viral / Q000235:genetics*; D005260:Female; D005500:Follow-Up Studies; D060005:Genotyping Techniques; D061809:Human Papillomavirus DNA Tests; D006801:Humans; D008403:Mass Screening; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis* / Q000601:surgery / Q000821:virology; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000150:complications / Q000175:diagnosis* / Q000601:surgery / Q000821:virology
chemical_list: D054316:Biomarkers, Pharmacological; D004279:DNA, Viral
keywords: Cervical lesions; Human papillomavirus; Post treatment; Test of cure; Testing strategies