High-risk human papillomavirus testing for monitoring patients treated for high-grade cervical intraepithelial neoplasia

Abstract

Aim: The aim of the present study was to examine the accuracy of high-risk human papillomavirus (HR-HPV) DNA detection as a predictor of residual or recurrent cervical intraepithelial neoplasia (CIN) after treatment of high-grade CIN. Methods: Ninety-five women treated by conization and loop electrosurgical excision procedure (LEEP) for high-grade CIN were followed-up with HR-HPV DNA testing (Hybrid Capture II test, Digene Diagnostics, Gaithersburg, MD, USA) and cytology at 3, 6, 12, 18 and 24 months after treatment. The outcome of our study was to detect the presence of CIN using colposcopy-directed biopsy within 24 months after treatment. Results: Women with recurrent or residual disease did not differ from women who were cured within clinicopathologic parameters at treatment Pre-treatment HR-HPV testing was positive in all cases. In the recurrent pre-treatment group HR-HPV loads were significantly higher than in the group with no recurrence (1065.5 +/- 852.3 vs 527.7 +/- 669.6, P = 0.003). Residual or recurrent disease was identified in 17 patients (17.9%) during a 24-month period. A Pap smear significantly predicted disease recurrence at the first follow-up visit only. At the 6-month visit, HR-HPV testing showed 100% sensitivity and negative predictive value (NPV). When both a Pap smear and a HR-HPV test were used together, 82% sensitivity, 76% specificity and 95% NPV was noted. Performance of resection margins (odds ratio (OR) 9.8; 95% confidence interval (CI), 3.0-32.7) and post-treatment HR-HPV load >100 RLU (OR 9.3; 95% CI, 2.2-38.2) were also significant. Conclusion: HR-HPV testing in conjunction with Pap smear offers clear advantages over single cytology when monitoring women treated for high-grade CIN.