<p>Evaluation of PCR-Reverse Dot Blot Human Papillomavirus Genotyping Test in Predicting Residual/Recurrent CIN 2+ in Posttreatment Patients in China</p>

Abstract

To assess the clinical value of the PCR-reverse dot blot human papillomavirus genotyping test during follow-up of patients with CIN grade 2 or worse (CIN 2+). Methods: Four hundred patients with CIN 2+ receiving treatment from January 2008 to January 2017 were included in our study. Postoperative follow-up procedures comprised HPV examination and cervical cytology every 3-6 months for the first 2 years and then followed up every 6-12 months. A pathology examination was performed when there was a positive funding for HPV 16/18 or an abnormal ThinPrep cytology test (TCT) with or without positive for HR-HPV according to the American Society for Coloscopy and Cervical Pathology (ASCCP) guidelines. Results: The median follow-up period was 27.10±12.47 months (ranging from 3 to 50 months). During follow-up, 12.00% (48/400) of the women developed residual/recurrent disease. The highest risk in CIN 2+ and CIN 3+ residual/recurrence was HPV-16/-18 (hazard ratio (HR)=12.898, 95% CI= 6.849-24.289; HR= 20.726, 95% CI= 9.64-44.562, respectively). Among the different follow-up methods, type-specific (TP) HR-HPV persistent infection showed the highest cumulative incidence risk (CIR) (84.62%, 95% CI=73.29-95.94) and HR (5.38, 95% CI= 2.596-11.149) during the 4-year follow-up period. At the CIN 2+ and CIN 3+ endpoints, TP-HPV testing had relatively high sensitivity (84.62%, 95% CI=73.29-95.94 and 89.28%, 95% CI= 77.83-100.00, respectively) and specificity (78.07%, 95% CI= 72.70-83.44 and 75.73%, 95% CI= 70.30-81.17, respectively). However, at the CIN 2+/CIN 3+ endpoint, TCT follow-up had a sensitivity of 60.42%/62.16% (95% CI=46.58-72.25/46.54-77.79) and specificity of 90.18%/88.72% (95% CI=86.95-93.41/85.35-92.10). Conclusion: TP HR-HPV follow-up can provide a reliable and sensitive clinical reference for CIN 2+ postoperative patients.

Practical Model for Residual/Recurrent Cervical Intraepithelial Lesions in Patients with Negative Margins after Cold-Knife Conization

“…In our study, 4% of HSIL patients experienced “treatment failure”, consistent with a prevalence of 3.5–12% recently reported by several authors [ 25 , 26 , 27 ]. Our study found that some pre-follow-up factors were associated with treatment failure, including HPV16, HPV18, or HR-HPV RLU/CO > 1000, more than three pregnancies, positive ECC, and improved lesions.…”

The role of multiple high‐risk human papillomavirus infection on the persistence recurrence of high‐grade cervical lesions after standard treatment: A systematic review and a meta‐analysis

“… 14–35 Multiple HR‐HPVs were checked at the time or shortly before treatment of HSIL in 20 studies, 14–31,34 and during follow‐up visits in four 21,27,33,35 ; in two cases multiple HR‐HPVs were checked both at conization and during follow‐up 21,27 . A total of 14 papers were from Asia, 14,16,19,22–24,26–28,30–32,34,35 and eight from Europe 15,17,18,20,21,25,29,33 . The design of the study included 15 retrospective cohort papers, 14,19,22–25,27–31,33–35 six prospective cohort studies, 15–18,21,26,32 and one case control study 20 .…”

“…A total of 14 papers were from Asia, 14,16,19,22–24,26–28,30–32,34,35 and eight from Europe 15,17,18,20,21,25,29,33 . The design of the study included 15 retrospective cohort papers, 14,19,22–25,27–31,33–35 six prospective cohort studies, 15–18,21,26,32 and one case control study 20 . Treatment modalities included exclusively loop electrosurgical excision procedure (LEEP) in 12 studies, 15,17–19,21,22,24,25,27,28,33,35 exclusive hysterectomy in three studies, 23,30,34 and a mixed of LEEP, laser or surgery in the remaining seven reports 14,16,20,26,29,31,32 .…”

“…After exclusion of records because of irrelevancy, duplications, HIV seropositive samples, and case reports, 22 studies were included in the quantitative analysis (Figure 1). Multiple HR-HPVs were checked at the time or shortly before treatment of HSIL in 20 studies, [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]34 and during follow-up visits in four 21,27,33,35 ; in two cases multiple HR-HPVs were checked both at conization and during follow-up. 21,27 A total of 14 papers were from Asia, 14,16,19,[22][23][24][26][27][28][30][31][32]34,35 and eight from Europe.…”

“…Multiple HR-HPVs were checked at the time or shortly before treatment of HSIL in 20 studies, [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]34 and during follow-up visits in four 21,27,33,35 ; in two cases multiple HR-HPVs were checked both at conization and during follow-up. 21,27 A total of 14 papers were from Asia, 14,16,19,[22][23][24][26][27][28][30][31][32]34,35 and eight from Europe. 15,17,18,20,21,25,29,33 The design of the study included 15 retrospective cohort papers, 14,19,…”