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Prediction of recurrence after treatment for high-grade cervical intraepithelial neoplasia: the role of human papillomavirus testing and age at conisation.
BJOG 2006; 113(11):1303-7BJOG

Abstract

OBJECTIVES

The aim of this study was to examine the accuracy of the presence of high-risk human papillomavirus (HR-HPV) DNA (HR-HPV DNA test) postconisation as prediction of recurrent or residual cervical intraepithelial neoplasia (CIN) after treatment of high-grade cervical intraepithelial lesions (CIN2+) in a prospective study and to compare this with follow-up cytology and the marginal status of the excised tissue.

DESIGN

Prospective follow-up study.

SETTING

Unselected women presenting at colposcopy clinic of University Hospital Gasthuisberg, Leuven.

POPULATION

Seventy-two women treated with conisation for CIN2 or CIN3.

METHODS

Women were followed by HR-HPV DNA test (Hybrid Capture II test of Digene) every 3 to 6 months. The same vial was used for cytology and the HR-HPV DNA test (SurePath). All women were further followed by colposcopy and cytology for 24 months at 6-month intervals. The outcome of the study was presence of >CIN2, proven with colposcopy-directed biopsy occurring within 24 months after treatment. HR-HPV status was correlated with recurrent or residual CIN2+.

MAIN OUTCOME MEASURES

Sensitivity, specificity, predictive values and diagnostic odds ratios to predict treatment failure or cure were computed for HR-HPV testing, marginal status and follow-up cytology. HR-HPV status was also correlated with section margins postconisation and with the first cervical smear.

RESULTS

In 6 of the 72 treated women (8%), residual or recurrent CIN occurred. Women with recurrence were significantly older than women without a recurrence (51.5 +/- 9.6 versus 39.8 +/- 12.2 years, P= 0.007). All six women with recurrence were HR-HPV positive, four had a positive follow-up smear (>or=atypical squamous cells of uncertain significance = ASCUS+) and only two had involved section margins. Among the 66 cured women, 15 were HR-HPV positive, 6 had an abnormal smear and 12 had positive section margins. Sensitivity of cytology, positive section margins and HR-HPV DNA positivity was 66.7, 33.3 and 100% to predict treatment failure. Specificity of the three tests was, respectively, 90.9, 81.8 and 77.3%. Women with HR-HPV DNA at 3 to 6 months showed recurrent or residual CIN in 15% (2/13) if they had normal follow-up Pap smears and in 50% (4/8) if they had abnormal Pap smears. Margin status was not statistically significantly associated with human papillomavirus status.

CONCLUSION

Persistence or clearance of HR-HPV DNA is an early valid prognostic marker of failure or cure after treatment for CIN2+ and is more accurate than cytology or section margin status at the time of conisation. The absence of HR-HPV DNA has a 100% negative predictive value. Higher age at conisation may be a previously unrecognised risk factor for recurrence.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium. jasper.verguts@uz.kuleuven.ac.beNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16978225

Citation

Verguts, J, et al. "Prediction of Recurrence After Treatment for High-grade Cervical Intraepithelial Neoplasia: the Role of Human Papillomavirus Testing and Age at Conisation." BJOG : an International Journal of Obstetrics and Gynaecology, vol. 113, no. 11, 2006, pp. 1303-7.
Verguts J, Bronselaer B, Donders G, et al. Prediction of recurrence after treatment for high-grade cervical intraepithelial neoplasia: the role of human papillomavirus testing and age at conisation. BJOG. 2006;113(11):1303-7.
Verguts, J., Bronselaer, B., Donders, G., Arbyn, M., Van Eldere, J., Drijkoningen, M., & Poppe, W. (2006). Prediction of recurrence after treatment for high-grade cervical intraepithelial neoplasia: the role of human papillomavirus testing and age at conisation. BJOG : an International Journal of Obstetrics and Gynaecology, 113(11), pp. 1303-7.
Verguts J, et al. Prediction of Recurrence After Treatment for High-grade Cervical Intraepithelial Neoplasia: the Role of Human Papillomavirus Testing and Age at Conisation. BJOG. 2006;113(11):1303-7. PubMed PMID: 16978225.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prediction of recurrence after treatment for high-grade cervical intraepithelial neoplasia: the role of human papillomavirus testing and age at conisation. AU - Verguts,J, AU - Bronselaer,B, AU - Donders,G, AU - Arbyn,M, AU - Van Eldere,J, AU - Drijkoningen,M, AU - Poppe,W, Y1 - 2006/09/15/ PY - 2006/9/19/pubmed PY - 2007/1/26/medline PY - 2006/9/19/entrez SP - 1303 EP - 7 JF - BJOG : an international journal of obstetrics and gynaecology JO - BJOG VL - 113 IS - 11 N2 - OBJECTIVES: The aim of this study was to examine the accuracy of the presence of high-risk human papillomavirus (HR-HPV) DNA (HR-HPV DNA test) postconisation as prediction of recurrent or residual cervical intraepithelial neoplasia (CIN) after treatment of high-grade cervical intraepithelial lesions (CIN2+) in a prospective study and to compare this with follow-up cytology and the marginal status of the excised tissue. DESIGN: Prospective follow-up study. SETTING: Unselected women presenting at colposcopy clinic of University Hospital Gasthuisberg, Leuven. POPULATION: Seventy-two women treated with conisation for CIN2 or CIN3. METHODS: Women were followed by HR-HPV DNA test (Hybrid Capture II test of Digene) every 3 to 6 months. The same vial was used for cytology and the HR-HPV DNA test (SurePath). All women were further followed by colposcopy and cytology for 24 months at 6-month intervals. The outcome of the study was presence of >CIN2, proven with colposcopy-directed biopsy occurring within 24 months after treatment. HR-HPV status was correlated with recurrent or residual CIN2+. MAIN OUTCOME MEASURES: Sensitivity, specificity, predictive values and diagnostic odds ratios to predict treatment failure or cure were computed for HR-HPV testing, marginal status and follow-up cytology. HR-HPV status was also correlated with section margins postconisation and with the first cervical smear. RESULTS: In 6 of the 72 treated women (8%), residual or recurrent CIN occurred. Women with recurrence were significantly older than women without a recurrence (51.5 +/- 9.6 versus 39.8 +/- 12.2 years, P= 0.007). All six women with recurrence were HR-HPV positive, four had a positive follow-up smear (>or=atypical squamous cells of uncertain significance = ASCUS+) and only two had involved section margins. Among the 66 cured women, 15 were HR-HPV positive, 6 had an abnormal smear and 12 had positive section margins. Sensitivity of cytology, positive section margins and HR-HPV DNA positivity was 66.7, 33.3 and 100% to predict treatment failure. Specificity of the three tests was, respectively, 90.9, 81.8 and 77.3%. Women with HR-HPV DNA at 3 to 6 months showed recurrent or residual CIN in 15% (2/13) if they had normal follow-up Pap smears and in 50% (4/8) if they had abnormal Pap smears. Margin status was not statistically significantly associated with human papillomavirus status. CONCLUSION: Persistence or clearance of HR-HPV DNA is an early valid prognostic marker of failure or cure after treatment for CIN2+ and is more accurate than cytology or section margin status at the time of conisation. The absence of HR-HPV DNA has a 100% negative predictive value. Higher age at conisation may be a previously unrecognised risk factor for recurrence. SN - 1470-0328 UR - https://www.unboundmedicine.com/medline/citation/16978225/Prediction_of_recurrence_after_treatment_for_high_grade_cervical_intraepithelial_neoplasia:_the_role_of_human_papillomavirus_testing_and_age_at_conisation_ L2 - https://doi.org/10.1111/j.1471-0528.2006.01063.x DB - PRIME DP - Unbound Medicine ER -