Clinical and economic benefit of HPV-load testing in follow-up and management of women postcone biopsy for CIN2–3

Abstract

This study aimed to evaluate the clinical and economic implications of integrating human papilloma virus (HPV) load testing into the follow-up and management protocol of women postconisation for high-grade cervical intraepithelial neoplasia (CIN2 -3). We evaluated 130 suitable women: 63 were screened biannually by Pap smears ('conventional approach') and 67 also had HPV-load testing ('HPV approach'). More stringent criteria for undergoing colposcopy or reconisation were observed by the former group compared to the latter. Both approaches were analysed for cost effectiveness. There were 33 out of 67 (49.2%) colposcopic referrals and 24 out of 67 (35.8%) reconisation/hysterectomies with the 'conventional approach' compared to 9 out of 63 (14.2%) and 7 out of 63 (11.1%) with the 'HPV approach'. Cervical intraepithelial neoplasia 2 -3 residual disease was detected in 7 out of 67 (10.5%) and 7 out of 63 (11.1%) women. The 'conventional approach' had more negative colposcopic biopsies and more negative reconisation/hysterectomy histologies than the 'HPV approach'. The respective cost per detection of one case of residual disease was US$3573 and US$3485. The 'HPV approach' required fewer colposcopic and reconisation procedures to detect one case of residual CIN2 -3. Its higher positive predictive value than that of cytology provided a significant decrease in false positive rates and a reduction of US$88 per detected case.

Role of high risk-human papilloma virus test in the follow-up of patients who underwent conization of the cervix for cervical intraepithelial neoplasia

“…Depending on the study, patients have been tested for HR-HPV at different times, including immediately after conization, 21 within 6 months after conization, [13][14][15]18,19,22 or at 6 months after conization (Table 2). 16,17 Nobbenhuis et al reported that results were similar at both 3 and 6 months after conization (Table 2). 17 The 2001 American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines recommend that testing be performed at least 6 months after treatment to provide sufficient time for clearance of the HPV infection, and that it can be performed at 12 months after treatment unless a patient has risk factors for persistent/recurrent CIN, such as a large lesion or endocervical extension.…”

“…The sensitivity, specificity, positive and negative predictive values of HR-HPV testing for detecting persistent or recurrent disease after conization have been reported in several studies (Table 2). [13][14][15][16][17][18][19] In particular, the negative predictive value was found to be very high in all studies. Depending on the study, patients have been tested for HR-HPV at different times, including immediately after conization, 21 within 6 months after conization, [13][14][15]18,19,22 or at 6 months after conization (Table 2).…”

“…1,[13][14][15][16][17][18][19][20][21][22] The 2001 ASCCP guidelines state that HR-HPV testing is acceptable for post treatment surveillance. 25 Post-conization HR-HPV testing is useful for detecting not only persistent disease but also recurrent disease.…”

“…However, these factors are suboptimal predictors, [4][5][6][7][8][9][10][11][12] and cannot be used to dictate the follow-up strategy after conization. While there is increasing evidence that testing for the presence of high risk-human papilloma virus (HR-HPV) after conization may help predict the likelihood of persistent or recurrent disease, 1,[13][14][15][16][17][18][19][20][21][22] no study has shown how HR-HPV testing might be integrated into post conization surveillance. The aim of this study was to determine whether HR-HPV test after conization is a predictive factor for CIN persistence or recurrence after LLETZ or CKC of the cervix.…”

The Value of HPV-HR DNA Testing During the Follow-Up After Treatment of CIN3/AIS

“…We can argue that these patients were unnecessarily exposed to peri-and postoperative morbidity. Some other studies also found a relatively high number of reoperated patients who had no residual/recurrent disease confirmed [4,9]. The decision for a second treatment in our study relied upon cytology and colposcopy protocol, mainly (81.2%) during the first year of follow-up.…”