title: The Role of High-Risk Human Papilloma Virus Testing in the Surveillance of Cervical Cancer After Treatment.
abstract: BACKGROUND
  Cervical cancer affects 12 000 women in the United States annually. However, despite its prevalence, there remains no good methodology to detect its recurrence.
  
  
  OBJECTIVE
  To identify the role of cervicovaginal high-risk human papilloma virus (hr-HPV) testing in predicting cervical cancer recurrence.
  
  
  METHODS
  This is a retrospective study of patients who underwent hr-HPV testing as part of their routine surveillance for cervical cancer. Standard statistical analyses, including χ² test and multivariable logistic regression, were performed with IBM SPSS 19.0.
  
  
  RESULTS
  A total of 133 patients were identified, of whom 107 (80%) had squamous cell carcinoma. Ninety patients (68%) had bulky disease and were treated primarily with chemoradiation and brachytherapy. Of patients whose disease recurred, 5 patients (42%) had tested positive for hr-HPV during their surveillance period, compared to 13 patients (11%) for whom disease did not recur (relative risk: 3.88, P = .002). On multivariate logistic regression, hr-HPV status remained significantly predictive of disease recurrence (odds ratio: 12.3, P = .02, 95% confidence interval: 1.5-99.6). Using 2 × 2 table analysis, we found that while cervicovaginal cytology has limited specificity (5.7%) in predicting recurrence, the combination of cytology with hr-HPV testing increases the specificity of testing to 89.3%.
  
  
  CONCLUSIONS
  Persistence of hr-HPV is a risk factor for disease recurrence. High-risk-HPV testing is not routinely used during surveillance for cervical cancer, but this study suggests that large, prospective trials investigating the role of hr-HPV testing in cervical cancer surveillance are needed.
authors.forename: Miao Crystal
authors.initials: MC
authors.lastname: Yu
authors.forename: R Marshall
authors.initials: RM
authors.lastname: Austin
authors.forename: Jeff
authors.initials: J
authors.lastname: Lin
authors.forename: Tiffany
authors.initials: T
authors.lastname: Beck
authors.forename: Sushil
authors.initials: S
authors.lastname: Beriwal
authors.forename: John T
authors.initials: JT
authors.lastname: Comerci
authors.forename: Robert P
authors.initials: RP
authors.lastname: Edwards
authors.forename: Paniti
authors.initials: P
authors.lastname: Sukumvanich
authors.forename: Joseph
authors.initials: J
authors.lastname: Kelley
authors.affiliation: From the Departments of Gynecology Oncology (Drs Yu, Lin, Comerci, Edwards, Sukumvanich, Kelley, and Olawaiye), Pathology (Dr Austin), and Radiation Oncology (Dr Beriwal), Magee-Women's Hospital, Pittsburgh, Pennsylvania; and the Department of Gynecology Oncology, University of Washington, Seattle (Dr Beck).
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Olawaiye
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000628:therapy / Q000821:virology; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D065006:Papanicolaou Test / Q000379:methods* / Q000706:statistics & numerical data; D027383:Papillomaviridae / Q000145:classification / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000821:virology; D011159:Population Surveillance / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000628:therapy / Q000821:virology; D014626:Vaginal Smears / Q000379:methods / Q000706:statistics & numerical data