Addition of high-risk HPV testing improves the current guidelines on follow-up after treatment for cervical intraepithelial neoplasia

Nobbenhuis, Mariëlle; Meijer, Chris J.L.M.; Brule, Adriaan J. C. van den; Rozendaal, Lawrence; Voorhorst, Feja J.; Risse, Elle K.J.; Verheijen, René H.M.; Helmerhorst, Theo J.M.

doi:10.1054/bjoc.2000.1689

Cited by 181 publications

(142 citation statements)

References 15 publications

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“…One study recommended including HR HPV test to monitor women initially treated for CIN 2 or 3. 20 They suggested that all women should be tested at 6 and 24 months after treatment, and should only be referred for routine cervical cancer screening when these tests are negative on both visits. They evaluated the predictive value of the follow-up HPV test in patients treated for CIN 2 or 3.…”

Section: Discussionmentioning

confidence: 99%

The utility of the human papillomavirus DNA load for the diagnosis and prediction of persistent vaginal intraepithelial neoplasia

Hwang

Song

et al. 2009

J Gynecol Oncol

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Objective: We evaluated the human papillomavirus (HPV) DNA load for the diagnosis and prediction of persistent vaginal intraepithelial neoplasia (VAIN). Methods: A retrospective review of the medical records of patients with a pathological diagnosis of VAIN was performed. Eligible women (N=48) were followed for cytology and HPV DNA test, and colposcopic biopsies were taken at 3-to 6-month intervals. Thirty-seven patients were followed for more than 6 months; their HPV DNA test results were compared to the cytology results for the prediction of disease prognosis. Results: The degree of VAIN was more severe in patients with a high initial HPV DNA load (p=0.009). Patients with VAIN 2 and VAIN 3 were older than those with VAIN 1 (p=0.005 and 0.008, respectively). In 26 out of 37 patients (70.3%), the VAIN resolved. The other patients had persistent lesions with no progression to invasive vaginal carcinoma. The last follow-up HPV DNA load was significantly higher in the group with persistent VAIN compared to the group with resolved VAIN (p＜0.0001). Negative cytology was observed in 25 out of 26 patients in the VAIN resolved group and in nine out of 11 patients in the VAIN persistent group (p=0.205). Conclusion: These results suggest that the HPV DNA test, especially for viral load, was more effective for the diagnosis and prediction of persistent VAIN than cytology.

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Section: Discussionmentioning

confidence: 99%

The utility of the human papillomavirus DNA load for the diagnosis and prediction of persistent vaginal intraepithelial neoplasia

Hwang

Song

et al. 2009

J Gynecol Oncol

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“…However, the average length of a hrHPV infection is 6-14 months. [11][12][13][14] Moreover, meta-analyses of women with ASCUS and LSIL cytology have reported rates CIN, cervical intraepithelial neoplasia; hrHPV, high-risk human papillomavirus; LLETZ, large loop excision of the transformation zone. *Over 3 years following detection by management policy or at exit examination (for further details, see reference 39 ).…”

Section: Strengths and Weaknessesmentioning

confidence: 99%

“…[8][9][10] However, HPV infections are common, and most are transient, with a median duration of 6-14 months. [11][12][13][14] Hence there is a need for rigorous evaluation of this potential application of HPV testing.…”

Section: Introductionmentioning

confidence: 99%

The role of human papillomavirus testing in the management of women with low‐grade abnormalities: multicentre randomised controlled trial

Cotton

Sharp

Little

et al. 2010

BJOG

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Objective To assess the value of a single human papillomavirus (HPV) test in making decisions on management of women with cervical cytology showing borderline nuclear abnormality (BNA) or mild dyskaryosis. In particular, to determine whether information on high-risk (hr) HPV status would be valuable in the choice between (1) cytological surveillance versus immediate referral to colposcopy, and (2) at colposcopy, between biopsy and recall versus immediate large loop excision of the transformation zone (LLETZ).Design Multicentre individually randomised controlled trial, nested within the NHS Cervical Screening Programmes, investigating the value of HPV testing by testing for interactions between HPV status and (1) cytological surveillance versus colposcopy, and (2) biopsy and recall versus immediate LLETZ.Setting Grampian, Tayside and Nottingham.Population Women (n = 4439), aged 20-59 years, with a cytology test showing borderline nuclear abnormalities or mild dyskaryosis during October 1999 to October 2002.Methods High-risk HPV status was determined at recruitment using the polymerase chain reaction assay with the GP5+/6+ general primer system. The results of this HPV testing were not disclosed to either the participating women or to those involved in their management. Women were randomised to either (1) 6-monthly cytological screening in primary care or (2) referral for colposcopy. Human papillomavirus status was used to stratify both randomisations. All women were followed for 3 years, concluding with an invitation to an exit appointment at which colposcopic examination was undertaken. In addition, in women who were randomised to initial colposcopy and underwent colposcopy, the association between hrHPV status and presence of cervical intraepithelial neoplasia (CIN) grade 2 or more severe disease (henceforth CIN2 or worse) was examined.Main outcome measures Sensitivity, specificity, positive and negative predictive values of the HPV test for predicting CIN2 or worse and the implications for the choice of management between cytological surveillance and immediate referral for colposcopy.Results There were no significant interactions between management and HPV status. Hence, in women with mild dyskaryosis or BNA who are HPV positive, there is no advantage of (1) immediate colposcopy over cytological surveillance (P = 0.76) or (2) immediate LLETZ over biopsy and recall (P = 0.27). The sensitivity of HPV testing for detection of CIN2 or worse was 75.2% (95% CI 68.8-81.0%) among women with mild dyskaryosis and 69.9% (95% CI 61.7-77.3%) among those with BNA. Specificity was higher in those with BNA (71.3%; 95% CI 68.5-74.1%) than in those with mild dyskaryosis (46.9%; 95% CI 42.2-51.6%). Sensitivity decreased with increasing age whereas specificity increased. The negative predictive value was high, particularly among women with BNA (94.5%; 95% CI 92.9-96.0%). Across all ages, 22% of women who had CIN2 or worse were HPV negative. Conversely, 40% of those who were HPV positive did not have CIN. HPV was a much more relia...

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“…Most other studies are prospective with fairly short follow up periods, a small number of patients and a minimal number of recurrences. 13 , 27 , 28 A Dutch study 29 reported high negative predictive value of post-treatment HPV-test, but only two women in this material developed high grade CIN later than 2 years after initial treatment. However, with a case-control design, Cruickshank and colleagues 30 had results in close concordance with ours.…”

Section: Discussionmentioning

confidence: 88%

Does HPV-status 6–12 months after treatment of high grade dysplasia in the uterine cervix predict long term recurrence?

Strander

Ryd

Wallin

et al. 2007

European Journal of Cancer

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Background-Women once treated for high grade cervical dysplasia have a high long term risk for developing new dysplasia or cancer.Objectives-To investigate if human papilloma virus (HPV)-negativity after treatment of cervical dysplasia reduces the need for frequent long term follow up.Design-Case/control study based on archival smears.Methods-Women with cervical intraepithelial neoplasi (CIN)2-3, treated for dysplasia and with recurrence of CIN2+ more than 2 years after treatment were compared with controls without recurrence, matched for age and date of treatment. High risk-HPV-DNA were analysed with PCR from two archival smears per woman. Mean follow up time was 14.6 years.Results-24% (45/189) of cases and 11% (43/378) of controls were HPV-positive in any of two smears. Odds ratio (OR) = 2.5 (1.6-3.8).Conclusion-HPV-status 6-12 months after treatment of high grade dysplasia is of limited value for the design of long term follow up.

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Addition of high-risk HPV testing improves the current guidelines on follow-up after treatment for cervical intraepithelial neoplasia

Cited by 181 publications

References 15 publications

The utility of the human papillomavirus DNA load for the diagnosis and prediction of persistent vaginal intraepithelial neoplasia

The utility of the human papillomavirus DNA load for the diagnosis and prediction of persistent vaginal intraepithelial neoplasia

The role of human papillomavirus testing in the management of women with low‐grade abnormalities: multicentre randomised controlled trial

Does HPV-status 6–12 months after treatment of high grade dysplasia in the uterine cervix predict long term recurrence?

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