Persistent HPV infection after conization in patients with negative margins

Song, Seung Hun; Lee, Jae Kwan; Oh, Min Jeong; Hur, Jun Young; Na, Jung Yeol; Park, Yong Kyun; Saw, Ho Suk

doi:10.1016/j.ygyno.2005.10.028

Cited by 45 publications

(50 citation statements)

References 21 publications

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“…We could not evaluate the performance of the generic assays for the screening of residual disease after treatment, as all 25 women treated for CIN 2/3 with adequate follow-up responded to therapy. Up to 20% of these women remain infected with HR HPV after treatment, as reported by others (1,19,20,22).…”

Section: Discussionsupporting

confidence: 55%

Human Papillomavirus (HPV) DNA Triage of Women with Atypical Squamous Cells of Undetermined Significance with Amplicor HPV and Hybrid Capture 2 Assays for Detection of High-Grade Lesions of the Uterine Cervix

et al. 2011

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Up to 20% of women having a cytology smear showing atypical squamous cells of undetermined significance (ASC-US) and infected with high-risk human papillomavirus (HR HPV) have high-grade cervical intraepithelial neoplasia (CIN 2/3). Results obtained with theHigh-risk human papillomavirus (HR HPV) genotypes are associated with high-grade cervical intraepithelial neoplasia (CIN 2/3) and cancer of the uterine cervix (2, 3). Primary screening of cervical cancer is essentially based on Pap cytology testing. In North America, for each new case of cervical cancer screened by cytology, there are between 50 and 100 cases of abnormal smears consistent with low-grade squamous intraepithelial lesions (LSIL) or high-grade squamous intraepithelial lesions (HSIL) (9). Additionally, there are at least twice as many cases of equivocal or borderline atypias, referred to as "atypical squamous cells of undetermined significance" (ASC-US). Three options have been proposed by the American Society for Colposcopy and Cervical Pathology to perform triage on women with ASC-US, namely, repeat cytology, immediate referral to colposcopy, and reflex HR HPV testing (28).The most widely used HR HPV detection assay for the triage of women with ASC-US is the Hybrid Capture 2 assay (HC-2; Qiagen, Inc., Mississauga, Ontario, Canada) (15). The HC-2 and Amplicor HPV (Roche Diagnostics, Laval, Quebec, Canada) tests detect the same 13 HR genotypes and are approved by Health Canada for clinical use. Several studies have evaluated the Amplicor HPV test, but only one analyzed fresh samples collected from women with ASC-US (4,11,14,15,25,26,27). The evaluation of the performance of the Amplicor HPV test in a diagnostic setting is mandatory to assess its utility in the management of women with ASC-US. We evaluated the clinical performance of two generic HPV assays, Amplicor HPV and HC-2, on fresh clinical specimens obtained prospectively from women referred to colposcopy because of an ASC-US cytology result. HPV genotypic analysis was performed on all samples to assess the cross-reactivity of the HPV generic assays. MATERIALS AND METHODSStudy design and population. Participants were recruited consecutively if (i) they were referred to colposcopy because of at least one ASC-US cytology, (ii) were Ն24 years old, and (iii) had not received treatment for CIN in the last 2 years. During the study period, HPV DNA testing was not widely available to primary care physicians in the study area and women were referred to colposcopy

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Section: Discussionsupporting

confidence: 55%

Human Papillomavirus (HPV) DNA Triage of Women with Atypical Squamous Cells of Undetermined Significance with Amplicor HPV and Hybrid Capture 2 Assays for Detection of High-Grade Lesions of the Uterine Cervix

et al. 2011

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“…Few studies have examined recurrence/persistence and direct HPV viral load. Song et al 15 reported that the pre-LEEP HR-HPV load was related to a higher risk of persistence of HPV in patients with negative margins after LEEP using multiple regression analysis. They used RLU/PC＞500 as a cutoff value for a high viral load determined by HCII and reported that among the possible risk factors, including age, parity, conization grade, histology of colposcopic biopsy, and HPV load, HPV load was the only significant factor.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have suggested risk factors for the prediction of residual/recurrent disease CIN after LEEP, although the results have been somewhat inconsistent. [13][14][15] Age, cytology grade, menopause status, margin involvement, and HPV viral load have all been observed as risk factors for residual/recurrent disease in CIN treatment. Positive margins in the excised specimen was the greatest risk factors for the development of recurrent CIN in many studies, 13,14 while a few recent studies identified the HPV viral load before LEEP as a predictor of persistence/recurrent disease.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with HPV persistence after conization in patients with negative margins

et al. 2009

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Objective: The clearance rate of human papillomavirus (HPV) after conization is generally high, although some HPV infections persist. We investigated the factors that affect the clearance of HPV after conization in patients with negative margins. Methods: We retrospectively analyzed 77 patients (mean age 39.9 years, range 25 to 51 years) with CIN 2/3 who underwent loop electrosurgical excision procedure (LEEP) conization with negative margins. All patients had a Pap smear and high-risk (HR) HPV testing using Hybrid Capture II system and HPV DNA chip before conization. We used≥1 relative light units (RLUs) as the cutoff for persistence of HPV after conization. Results: High-risk HPV was detected in 73 of 77 (94.8%) patients before conization. At the 6-months follow-up, the high-risk HPV was eliminated in 60 of 73 (82.2%) patients. The HPV persistence rate after conization was 17.8% (13/73). Univariate analysis showed that persistent HPV infection after conization with negative margins was more likely to occur when the pretreatment viral load was high (RLU/positive control ＞100 (p=0.027) and the HPV was type 16 (p=0.021). Logistic regression analysis showed that preoperative HPV type 16 infection was the only significant independent factor (p=0.021) for HPV persistence out of age, cytology, punch biopsy histology, HPV viral load, and conization histology. Conclusion: Conization effectively removes HR-HPV infection. HPV type 16 infection before conization was significantly related to HR-HPV persistence after conization with negative margins. Therefore, patients with HPV 16 infection before conization need to be followed closely.

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“…Some studies suggest a role for advanced age, infection with multiple HPV subtypes, infection with high-risk HPV subtypes, host immunodeficiency, and host genetics in the development of chronic HPV infection and eventual carcinoma [11,[13][14][15][16][17][18]. This process is thought to be exceedingly slow, with progression from high-grade dysplasia (CIN2/3) to cervical carcinoma requiring an estimated 20 years or more [19].…”

Section: Pathophysiology and Risk Factorsmentioning

confidence: 99%