The Value of HPV-HR DNA Testing During the Follow-Up After Treatment of CIN3/AIS

Abstract

There is still debate on what is the optimal follow-up protocol after a treatment for preinvasive cervical disease. We performed this study in order to improve diagnostic accuracy of the follow-up protocol and at the same time reducing the number of overtreated patients. One hundred and fourteen patients were followed up after conization for CIN3 and/or AIS at 3-6 month, 9-12 month and 18-24 month intervals, then yearly. The follow-up consisted of cytology, colposcopy with biopsy if needed and HPV testing. The end-point of the study was a secondary treatment due to a high suspicion of resdidual/recurrent disease or disease free period of at least 24 months. The median follow-up time was 41 months (5-72 months). In predicting residual/recurrent disease cytology had a specificity of 88.9%, sensitivity of 100%, PPV of 33.3% and a NPV of 100% whereas HPV had a specificity of 76.9%, sensitivity of 100%, PPV of 21.4% and a NPV of 100%. According to our results both tests can be used as a primary follow-up tool after conization. The choice should depend on a socio-economic aspect. In our setting the HPV test should be done only in those patients with a positive smear any time during follow-up as the point of decision for a second treatment. With this approach we could considerably decrease the number of reoperated patients and co-morbidities.

Development of evidence-based guidelines for follow up of women treated for cervical intraepithelial neoplasia grade 2 or 3 (CIN2/3) in Italian screening programmes

“…Sixteen primary studies [9,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] and 4 systematic reviews [47][48][49][50] were included for the role of surgical margins, including one systematic review (summarizing 14 primary works) focusing on the stratified analyses by HPV status that was considered particularly relevant by the panel. Thirteen papers were included for women's age [9,32,33,37,40,42,45,[51][52][53][54][55][56], five for the underlying cytology [34,41,45,55,57] four for viral load [34,45,54,58], seven for grade of CIN [8,9,33,36,37,57,…”

“…For the question comparing 6 with 12 month interval between intervention and the first follow up episode, 22 studies were included [8,9,24,25,34,36,43,44,46,51,[63][64][65][66][67][68][70][71][72][73][74][75], including 7497 women who received their first control at 6 months and 1285 at 12 months. Out of the 18 studies useful for this outcome, only 5 invasive cancers were found, all in the 6 month group (Table 3).…”

“…Evidence was rated very low for this outcome because of the small number of women with test at 12 months. For the quantification of HPV positivity, 20 studies reporting 9939 and 1285 women with first control at 6 and 12 months, respectively, were considered; restricting the analysis to comparison between 6 and 12 months in the same population, five studies including 1819 women were included [43,44,63,67,72]. Both analyses suggest that HPV clearance is only slightly lower at 12 months compared to 6 months (about 2 percent points absolute difference) (Ta-ble 3).…”