The role of genotype-specific human papillomavirus detection in diagnosing residual cervical intraepithelial neoplasia

✍ Scribed by Ruud LM Bekkers; Willem JG Melchers; Judith MJE Bakkers; Antonius GJM Hanselaar; Wim GV Quint; Henk Boonstra; Leon FAG Massuger

• Publisher: John Wiley and Sons
• Year: 2002
• Tongue: French
• Weight: 73 KB
• Volume: 102
• Category: Article
• ISSN: 0020-7136
• DOI: 10.1002/ijc.10691

✦ Synopsis

Abstract

We assessed prospectively whether residual cervical intraepithelial neoplasia (CIN) after treatment for high‐grade CIN can be predicted by genotype‐specific high‐risk HPV (HR‐HPV) detection in follow‐up cervical scrapes. A broad spectrum, highly sensitive SPF~10~‐LiPA‐PCR HPV detection technique was used on cervical scrapes before large loop excision of the transformation zone (LLETZ), on the LLETZ biopsy and on follow‐up scrapes of 90 patients treated for high‐grade CIN. HR‐HPV was detected in the biopsies of 93% (n = 84) of the patients and in the follow‐up scrapes of 48% (n = 43) of the patients. In 12 patients, genotype‐specific HR‐HPV persistence was detected in both follow‐up scrapes. In 10 patients, residual CIN was detected. In 5 of these patients (including all patients with residual CIN 3), the follow‐up scrapes showed genotype‐specific HR‐HPV persistence. In 2 patients, a different HR‐HPV was detected, and 3 patients had HR‐HPV‐negative follow‐up scrapes. Conventional cytologic follow‐up was abnormal in 13 patients including all 10 patients with residual CIN. The negative predictive value (NPV) of HR‐HPV detection on follow‐up scrapes was high (94%). Repeat detection of genotype‐specific HR‐HPV showed a lower sensitivity and NPV than repeat detection of any HR‐HPV, but its specificity was higher. Repeat conventional cytologic follow‐up showed the highest sensitivity and NPV. In conclusion, the presence of HR‐HPV in cervical scrapes after LLETZ for high‐grade CIN is a risk factor for the presence of residual CIN. HR‐HPV genotype‐specific persistence is specifically present in patients with residual CIN 3. However, HR‐HPV detection cannot predict or exclude the presence of residual CIN in the individual patient and additional procedures remain necessary. © 2002 Wiley‐Liss, Inc.