High-risk HPV-positive and -negative high-grade cervical dysplasia: Analysis of 5-year outcomes

Bogani, Giorgio; Sopracordevole, Francesco; Donato, Violante Di; Ciavattini, Andrea; Ghelardi, Alessandro; Lopez, Salvatore; Simoncini, Tommaso; Plotti, Francesco; Casarin, Jvan; Serati, Maurizio; Pinelli, Ciro; Valenti, Gaetano; Bergamini, Alice; Gardella, Barbara; Dell’Acqua, A.; Monti, Ermelinda; Vercellini, Paolo; Fischetti, Margherita; D’Ippolito, Giovanni; Aguzzoli, Lorenzo; Mandato, Vincenzo Dario; Carunchio, Paola; Carlinfante, Gabriele; Giannella, Luca; Scaffa, Cono; Falcone, Francesca; Borghi, Chiara; Ditto, Antonino; Malzoni, Mario; Giannini, Andrea; Salerno, Maria Giovanna; Liberale, Viola; Contino, Biagio; Donfrancesco, Cristina; Desiato, Michele; Perrone, Anna Myriam; Dondi, Giulia; Iaco, Pierandrea De; Chiappa, Valentina; Ferrero, Simone; Sarpietro, Giuseppe; Matarazzo, Maria Grazia; Cianci, Antonio; Bosio, Sara; Ruisi, Simona; Guerrisi, Rocco; Brusadelli, Claudia; Mosca, Lavinia; Laganà, Antonio Simone; Tinelli, Raffaele; Signorelli, Mauro; Vincenzo, Rosa De; Zannoni, Gian Franco; Ferrandina, Gabriella; Lovati, Sara; Petrillo, Marco; Dessole, Salvatore; Carlea, Annunziata; Zullo, Fulvio; Angioli, Roberto; Greggi, Stefano; Spinillo, Arsenio; Ghezzi, Fabio; Colacurci, Nicola; Muzii, Ludovico; Panici, Pierluigi Benedetti; Scambia, Giovanni; Raspagliesi, Francesco

doi:10.1016/j.ygyno.2021.01.020

Cited by 45 publications

(50 citation statements)

References 17 publications

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“…The best available evidence regards the prevention of recurrent CIN after surgical treatment [36][37][38]. A recent meta-analysis [39], including 11 studies and 21,310 patients, demonstrated that providing HPV vaccine as an adjunct to conization for CIN reduces the risk of recurrence.…”

Section: Discussionmentioning

confidence: 99%

HPV Vaccination after Primary Treatment of HPV-Related Disease across Different Organ Sites: A Multidisciplinary Comprehensive Review and Meta-Analysis

et al. 2022

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Objective: To assess evidence on the efficacy of adjuvant human papillomavirus (HPV) vaccination in patients treated for HPV-related disease across different susceptible organ sites. Methods: A systematic review was conducted to identify studies addressing the efficacy of adjuvant HPV vaccination on reducing the risk of recurrence of HPV-related preinvasive diseases. Results were reported as mean differences or pooled odds ratios (OR) with 95% confidence intervals (95% CI). Results: Sixteen studies were identified for the final analysis. Overall, 21,472 patients with cervical dysplasia were included: 4132 (19.2%) received the peri-operative HPV vaccine, while 17,340 (80.8%) underwent surgical treatment alone. The recurrences of CIN 1+ (OR 0.45, 95% CI 0.27 to 0.73; p = 0.001), CIN 2+ (OR 0.33, 95% CI 0.20 to 0.52; p < 0.0001), and CIN 3 (OR 0.28, 95% CI 0.13 to 0.59; p = 0.0009) were lower in the vaccinated than in unvaccinated group. Similarly, adjuvant vaccination reduced the risk of developing anal intraepithelial neoplasia (p = 0.005) and recurrent respiratory papillomatosis (p = 0.004). No differences in anogenital warts and vulvar intraepithelial neoplasia recurrence rate were observed comparing vaccinated and unvaccinated individuals. Conclusions: Adjuvant HPV vaccination is associated with a reduced risk of CIN recurrence, although there are limited data regarding its role in other HPV-related diseases. Further research is warranted to shed more light on the role of HPV vaccination as adjuvant therapy after primary treatment.

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Section: Discussionmentioning

confidence: 99%

HPV Vaccination after Primary Treatment of HPV-Related Disease across Different Organ Sites: A Multidisciplinary Comprehensive Review and Meta-Analysis

et al. 2022

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“…Patients with HR-HPV-positive cervical CIN3 lesions had a higher 5-year risk of recurrence, which was eight times higher than that of HPV-uninfected patients. [11] Of the patients examined in the present study, 146 were treated with conization; of them, 118 became HPV-negative within 2 years and 28 showed persistent HPV infection for more than 2 years. All of these patients were less than 35 years; 22 of them did not use barrier contraception and 6 had multiple high-risk HPV infections.…”

Section: Discussionmentioning

confidence: 81%

HPV conversion rates after LEEP, cold-knife conization, and laser and drug therapy: A 4-year follow-up study

Yi¹,

Chen²,

Liu³

et al. 2022

Preprint

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Objective: To assess the clinical outcomes of women with human papilloma virus (HPV) infection and cervical lesions after treatment with the loop electrosurgical excision procedure (LEEP), cold-knife conization, laser and drug therapies.Methods: This retrospective study reviewed medical data from 215 women with HPV infection and cervical lesions, treated with LEEP [n=122 (56.74%)], cold-knife conization [n=24 (11.16%)], laser therapy [n=10 (4.66%)], or pharmacotherapy [n=59 (27.44%)], respectively, between October 2016 and August 2017 at Fujian Provincial Maternal and Children’s Health Hospital. The risk factors and clinical outcomes of HPV infection and cervical lesions were follow-up for at least 4 years. Furthermore, the Kaplan-Meier method was utilized to analyze the time to HPV regression after treatment.Results: Overall, 145 patients (67.44%) showed improvement after treatment. The efficacy of conization and LEEP in achieving short-term HPV conversion was significantly better than that of laser and drug treatment (26.43% vs. 5.01%, P=0.04). The study revealed that menopause[odds ratio (OR), 2.61, 95% confidence interval (CI), 0.41-4.81, P=0.01];, high-risk HPV infection (OR, 3.6, 95% CI, 0.69-2.71, P=0.02) and a short follow-up (<6 months) (OR, 4.2, 95% CI, 0.31-8.09, P=0.02) were risk factors for poor treatment outcomes ;and OR, 3.25, 95% CI, 1.24-5.17, 2 P=0.01, respectively).Conclusions: Menopause affected outcomes in women with HPV infection. Conization was beneficial for short-term HPV conversion and may be indicated in individuals who were older than 50 years and had high-level cervical lesions and persistent HPV infection. The treatment of HPV infection with laser and pharmacological therapies needs more time.

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“…For these patients, cervical biopsy along with cervical curettage should be performed. If the results are negative, cervical conization should be considered to reduce the missed diagnosis of cervical malignant tumors and high-grade cervical dysplasia ( 13 ). A multicenter retrospective study showed that patients who had a preoperative diagnosis through conization had a significantly lower rate of recurrence than those who underwent cervical biopsy ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Giant Pelvic Cystic Appearance—An Unusual Feature of Uterine Cervical Adenocarcinoma

Wang

Xue

2022

Front. Surg.

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Cervical adenocarcinoma can present as a solid, mixed solid, cystic, or multiple cystic cervical mass in the endocervical canal. In this report, we present an extremely rare case of cervical adenocarcinoma with giant cystic lesions. A 37-year-old Chinese woman with a regular menstrual cycle presented to her local doctor complaining of mild abdominal distension. Abdominal ultrasonography suggested an ovarian cyst, whose mean diameter increased from 3 to 8 cm in 3 months. Thereafter, she was referred to our hospital. She had no abnormal vaginal bleeding or discharge. Transvaginal ultrasonography revealed a 95 × 80 mm cyst below the back of the uterus. Computed tomography revealed a 9.8 × 8.5 cm multilocular cyst between the cervix and right ovary. Human papillomavirus (HPV)-E6 and -E7 mRNA tests revealed HPV-16 positivity. The thin-layer, liquid-based cytological test of the cervix showed negative results. No tumor lesions were observed on the cervical biopsy histopathology. The lesion was misdiagnosed as an ovarian cyst prior to the surgery. Intraoperatively, a cyst of the size of a child's head was observed extending from the low posterior wall of the uterus to the posterior lip of the cervix, and the cervical cysts were resected. Histological examination revealed cervical adenocarcinoma. Subsequently, she underwent extensive hysterectomy, bilateral salpingectomy, and pelvic lymphadenectomy. The final diagnosis was stage IB3 cervical adenocarcinoma. After 21 months of follow-up, no clinical or radiological evidence of recurrence has been found.

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High-risk HPV-positive and -negative high-grade cervical dysplasia: Analysis of 5-year outcomes

Cited by 45 publications

References 17 publications

HPV Vaccination after Primary Treatment of HPV-Related Disease across Different Organ Sites: A Multidisciplinary Comprehensive Review and Meta-Analysis

HPV Vaccination after Primary Treatment of HPV-Related Disease across Different Organ Sites: A Multidisciplinary Comprehensive Review and Meta-Analysis

HPV conversion rates after LEEP, cold-knife conization, and laser and drug therapy: A 4-year follow-up study

Case Report: Giant Pelvic Cystic Appearance—An Unusual Feature of Uterine Cervical Adenocarcinoma

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