Type-specific HPV geno-typing improves detection of recurrent high-grade cervical neoplasia after conisation
✍ Scribed by Julie Heymans; Ina H. Benoy; Willy Poppe; Christophe E. Depuydt
- Publisher
- John Wiley and Sons
- Year
- 2011
- Tongue
- French
- Weight
- 129 KB
- Volume
- 129
- Category
- Article
- ISSN
- 0020-7136
No coin nor oath required. For personal study only.
✦ Synopsis
Abstract
The aim of this case–control study was to examine if type‐specific human papillomavirus (HPV) DNA geno‐typing before and after treatment of high‐grade cervical intra‐epithelial neoplasia (CIN) improves prediction of recurring or persisting CIN 2 or 3 compared with follow‐up cytology or high‐risk (hr)HPV testing. Women with biopsy‐proven recurrence of CIN 2 or 3 (cases) in a follow‐up period of at least 24 months after treatment of high‐grade CIN were compared with women without recurrence (controls). These cohorts were identified by a database search of the Riatol Laboratoria (Antwerp, Belgium). In a cohort of 823 women treated with conisation for high‐grade CIN between January 2001 and December 2007, 21 patients with a histologically proven recurrence of CIN2+ were identified. A group of women (n = 42) from the same cohort without recurrence was randomly chosen. We found that hrHPV testing at 6 months post‐treatment is significantly more sensitive compared with follow‐up cytology (ratio: 1.31, 95% confidence interval (CI): 1.10–1.54), but less specific (ratio: 0.85, 95% CI: 0.81–0.90) to predict failure of treatment. When compared with hrHPV testing, HPV geno‐typing is more efficient (equal sensitivity, but higher specificity, ratio: 1.43, 95% CI: 1.280–1.62). When compared with follow‐up cytology, HPV geno‐typing is more sensitive (ratio: 1.31, 95% CI: 1.10–1.54) and more specific (ratio: 1.22, 95% CI: 1.14–1.36). All women who developed a recurrence tested positive for hrHPV. The negative predictive value in the absence of hrHPV DNA was 100%. Six months after treatment HPV geno‐typing is the most sensitive and specific method to predict recurrent or persistent CIN 2‐3 in the next 24 months.