Prediction of recurrent disease by cytology and HPV testing after treatment of cervical intraepithelial neoplasiaObjective: To assess the role of human papillomavirus (HPV) testing and cytology as predictors of residual ⁄ recurrent disease after treatment of high-grade cervical intraepithelial lesions. Methods: One hundred and thirty-eight women with cervical intraepithelial neoplasia (CIN) grade 2 ⁄ 3 lesion on biopsy were included in a prospective follow-up study in Belgium and Nicaragua. All women were treated with loop electrosurgical excision procedure (LEEP) and follow-up visits took place at 6 weeks, 6 months, 1 year and 2 years. During these visits, a Papanicolaou (Pap) smear test was taken, colposcopy was performed and specimens were collected for HPV testing. Cytology, high-risk (HR) HPV presence, persistent HR HPV infection and combinations of these tests at different time points during follow-up were correlated with histologically confirmed residual ⁄ recurrent disease. Results: Thirteen patients (9%) developed residual ⁄ recurrent disease during follow-up. Abnormal cytology at 6 weeks after treatment was significantly correlated with residual ⁄ recurrent disease. Nine of thirty-seven patients with abnormal cytology at 6 weeks had recurrent disease versus three of seventy with a normal cytology [odds ratio (OR): 7.2; 95% confidence interval (CI): 1.8-28.5; P = 0.003). Sensitivity of this test was 75.0%, specificity 70.5%. Combining abnormal cytology and the presence of HR HPV within the first 6 months after treatment gave the best correlation with residual ⁄ recurrent disease: of the 54 women with abnormal cytology and ⁄ or HR HPV presence within the first 6 months, 11 developed residual ⁄ recurrent disease (OR 10.2; 95% CI: 2.2-48.3). Sensitivity of this combination was 84.6% and specificity 65.0%. Conclusion: Cytology remains the cornerstone in the early follow-up after LEEP for CIN lesions of the cervix. HPV testing can add value as it increases the sensitivity of cytology in concomitant testing within the first 6 months.

The role of types 31, 51 and 52 should be considered in future studies on vaccine development.

A process of rapid repair of dermal-epidermal adherence, as found in experiments with interrupted suction, was investigated electron microscopically. Biopsies in different stages of the process of suction blister formation and of the repair process were studied. Results show that suction blister formation occurs by successive detachment of hemidesmosomes from the basement membrane, and that, after partial separation of the epidermis from the dermis, a rapid regeneration of the dermal-epidermal junction takes place. This regeneration process apparently consists of two steps: realignment of basal cells to the basement membrane accompanied by autophagocytosis of detached hemidesmosomes, and de novo formation of hemidesmosomes. The time required for this structural regeneration corresponds well with the speed of the functional repair of dermal-epidermal adherence measured with the technique of interrupted suction.

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