Intraoperative post‐conisation human papillomavirus testing for early detection of treatment failure in patients with cervical intraepithelial neoplasia: a pilot study

Abstract

Objective To evaluate the feasibility and utility of intraoperative post-conisation human papillomavirus (IOP-HPV) testing and cytology to detect treatment failure in patients with cervical intraepithelial neoplasia grades 2-3 (CIN2-3).Design Prospective observational pilot study.Setting Barcelona, Spain.Population A cohort of 132 women treated for CIN2-3 by loop electrosurgical conisation.Methods An endocervical sample was obtained intraoperatively with a cytobrush from the cervix remaining after the conisation. The material was kept in PreservCyt medium and processed for Hybrid Capture 2 and cytology. Patients were followed-up for 24 months. The performance of IOP-HPV testing and IOP cytology was compared with conventional indicators of recurrence (cone margin, endocervical curettage, and HPV testing and cytology at 6 months).Main outcome measure Treatment failure (i.e. recurrent CIN2-3 during follow-up).Results Treatment failure was identified in 12 women (9.1%). IOP-HPV testing for sensitivity, specificity, and positive and negative predictive values for treatment failure were 91.7, 78.3, 62.2, and 96.0%, respectively, which are similar to the figures for conventional HPV testing at 6 months (91.7, 76.0, 64.0, and 95.1%, respectively), and are better than the values of other conventional predictive factors (cone margin, endocervical curettage, and cytology intraoperative at 6 months). IOP-HPV was strongly associated with treatment failure in the multivariate analysis (OR 15.40, 95% CI 1.58-150.42).Conclusion IOP-HPV testing is feasible, and accurately predicts treatment failure in patients with CIN2-3. This new approach may allow an early identification of patients with treatment failure, thereby facilitating the scheduling of an attenuated follow-up for negative patients who are at very low risk of persistent disease.Keywords Cervical intraepithelial neoplasia, conisation, human papillomavirus, post-treatment follow-up.Please cite this paper as: Torné A, Fusté P, Rodríguez-Carunchio L, Alonso I , del Pino M, Nonell R, Cardona M, Rodríguez A, Castillo P, Pahisa J, Balasch J, Ramírez J, Ordi J. Intraoperative post-conisation human papillomavirus (IOP-HPV) testing for early detection of treatment failure in patients with cervical intraepithelial neoplasia: a pilot study. BJOG 2013;120:392-399.

Role of human papillomavirus testing and cytology in follow‐up after conization

“…Safe return of women who have undergone conization to the primary screening program requires a high negative predictive value, which we obtained with both cytology (99.2%) and HPV testing (99.8%). Similar values have been found in previous studies, with, however, a tendency to slightly higher estimates for the negative predictive value of HPV than that of cytology . As the prevalence of relapse after conization is low, differences in negative predictive value should be interpreted with caution.…”

Evaluation of the intraoperative human papillomavirus test as a marker of early cure at 12 months after electrosurgical excision procedure in women with cervical high‐grade squamous intraepithelial lesion: a prospective cohort study

“…This is one of the few studies available evaluating intraoperative HPV testing as an early marker for disease recurrence in cervical HSIL . It also highlights the value of HPV 16 genotyping in the assessment of this risk.…”

“…A recent study by Torné et al . suggested that an HPV test performed intraoperatively could be an early marker of HSIL recurrence.…”

Incomplete excision of cervical precancer as a predictor of treatment failure: a systematic review and meta-analysis

“…A total of 97 studies, published between Jan 1, 1975, and Feb 1, 2016, were eligible for inclusion in the meta-analysis (figure 1), 65 of which were included in the previous meta-analysis by Ghaem-Maghami and colleagues, 14 assessing the risk of treatment failure associated with incomplete excision. Additionally, 15 studies [96][97][98][99][100][101][102][103][104][105][106][107][108][109][110] were identified from previous meta-analyses 9,111,112 assessing the accuracy of post-treatment HPV and or cytology testing to detect residual or recurrent CIN2+ and contained data for the margin status. 16 new reports 15,[113][114][115][116][117][118][119][120][121][122][123][124][125][126][127][128] were added that had not been included in previous reviews.…”