Human Papillomavirus Testing Following Loop Electrosurgical Excision Procedure Identifies Women at Risk for Posttreatment Cervical Intraepithelial Neoplasia Grade 2 or 3 Disease

Abstract

Background: Loop electrosurgical excision procedure (LEEP) is the predominant treatment for cervical intraepithelial neoplasia grade 2 or 3 (CIN2+) in the United States, yet following treatment f10% of women are diagnosed again with CIN2+, necessitating close follow-up of such patients. Methods: Surveillance strategies using cytology and/or human papillomavirus (HPV) testing were compared among women who underwent LEEP (n = 610) in the Atypical Squamous Cells of Undetermined Significance (ASCUS) Low-Grade Squamous Intraepithelial Lesion (LSIL) Triage Study. Cervical specimens, collected at 6-month visits for 2 years, were used for cytology, Hybrid Capture 2 (HC2) detection of carcinogenic HPVs, and PCR for genotyping of carcinogenic and noncarcinogenic HPV types. At exit, women had colposcopy for safety and disease ascertainment. Results: At the visit post-LEEP (median time: 4.5 months after LEEP), 36.9% [95% confidence interval (95% CI), 32.7-41.1%] of women were positive for carcinogenic HPV by PCR and 33.7% (95% CI, 29.7-37.9) had ASCUS or more severe (AS-CUS+) cytology. The overall 2-year cumulative incidence of histologically confirmed posttreatment CIN2+ was 7.0%; this could be further stratified by the HPV risk category detected

Clinical Performance of Hybrid Capture 2 Human Papillomavirus Testing for Recurrent High-Grade Cervical/Vaginal Intraepithelial Neoplasm in Patients With an ASC-US Papanicolaou Test Result During Long-Term Posttherapy Follow-up Monitoring

“…1,19,20 The risk of CIN 2þ after colposcopic examination in women who had an ASC-US Pap result with HC2 result has been reported previously. 22 However, it remains unclear whether HC2 HPV testing is efficient in predicting CIN 2þ in women with ASC-US during posttherapy follow-up.…”

“…In short-term follow-up, rates of recurrent/ residual CIN/VAIN 2þ ranged from 7% to 17.9%. [18][19][20][25][26][27] There are very few reports of long-term follow-up monitoring studies. In a large cohort of patients treated for CIN 3, Melnikow et al 5 reported a rate of recurrent/ residual CIN 2þ of 14%.…”

“…1,[19][20][21] Pap cytology is routinely used at our hospital for followup monitoring of women who have been treated for CIN/ VAIN 2þ or cervical carcinoma. Colposcopic evaluation is usually required for patients who have Pap results of abnormal squamous cells of undetermined significance, cannot exclude high-grade squamous intraepithelial lesion (ASC-H); low-grade squamous intraepithelial lesion (LSIL); or high-grade squamous intraepithelial lesion (HSIL).…”

“…Unlike polymerase chain reaction (PCR)-based HPV assays, the HC2 assay does not rely on target amplification, and thus its analytic sensitivity is lower than that of the PCR-based assays. In a study with the largest reported cohort of patients in posttherapy follow-up, Kreimer et al 20 compared the HC2 assay with a PCR assay in predicting recurrent/residual CIN 2þ. The results showed that the sensitivity of the PCR assay (97%) was higher than that of the HC2 assay (91%).…”

Human Papillomavirus Infection After Treatment for High-Grade Cervical Intraepithelial Neoplasia

“…One of the recognized treatment methods of CIN is conization. Numerous studies have shown that successful CIN treatment results in clearance of HPV infection and treatment failure is accompanied by the detection of viral persistence during posttreatment follow-up (1,3,4,9,13,14,18,23). On the basis of these data, follow-up testing for high risk HPV of CIN treated patients is now accepted as an option for monitoring for recurrent disease.…”