Factors associated with HPV persistence after treatment for high-grade cervical intra-epithelial neoplasia with large loop excision of the transformation zone (LLETZ)

Sarian, Luís Otávio; Derchain, Sophie; Pitta, Denise da Rocha; Morais, Sirlei Siani; Rabelo-Santos, Sílvia Helena

doi:10.1016/j.jcv.2004.05.012

Cited by 73 publications

(68 citation statements)

References 29 publications

(32 reference statements)

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“…We could not evaluate the performance of the generic assays for the screening of residual disease after treatment, as all 25 women treated for CIN 2/3 with adequate follow-up responded to therapy. Up to 20% of these women remain infected with HR HPV after treatment, as reported by others (1,19,20,22).…”

Section: Discussionsupporting

confidence: 54%

Human Papillomavirus (HPV) DNA Triage of Women with Atypical Squamous Cells of Undetermined Significance with Amplicor HPV and Hybrid Capture 2 Assays for Detection of High-Grade Lesions of the Uterine Cervix

et al. 2011

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Up to 20% of women having a cytology smear showing atypical squamous cells of undetermined significance (ASC-US) and infected with high-risk human papillomavirus (HR HPV) have high-grade cervical intraepithelial neoplasia (CIN 2/3). Results obtained with theHigh-risk human papillomavirus (HR HPV) genotypes are associated with high-grade cervical intraepithelial neoplasia (CIN 2/3) and cancer of the uterine cervix (2, 3). Primary screening of cervical cancer is essentially based on Pap cytology testing. In North America, for each new case of cervical cancer screened by cytology, there are between 50 and 100 cases of abnormal smears consistent with low-grade squamous intraepithelial lesions (LSIL) or high-grade squamous intraepithelial lesions (HSIL) (9). Additionally, there are at least twice as many cases of equivocal or borderline atypias, referred to as "atypical squamous cells of undetermined significance" (ASC-US). Three options have been proposed by the American Society for Colposcopy and Cervical Pathology to perform triage on women with ASC-US, namely, repeat cytology, immediate referral to colposcopy, and reflex HR HPV testing (28).The most widely used HR HPV detection assay for the triage of women with ASC-US is the Hybrid Capture 2 assay (HC-2; Qiagen, Inc., Mississauga, Ontario, Canada) (15). The HC-2 and Amplicor HPV (Roche Diagnostics, Laval, Quebec, Canada) tests detect the same 13 HR genotypes and are approved by Health Canada for clinical use. Several studies have evaluated the Amplicor HPV test, but only one analyzed fresh samples collected from women with ASC-US (4,11,14,15,25,26,27). The evaluation of the performance of the Amplicor HPV test in a diagnostic setting is mandatory to assess its utility in the management of women with ASC-US. We evaluated the clinical performance of two generic HPV assays, Amplicor HPV and HC-2, on fresh clinical specimens obtained prospectively from women referred to colposcopy because of an ASC-US cytology result. HPV genotypic analysis was performed on all samples to assess the cross-reactivity of the HPV generic assays. MATERIALS AND METHODSStudy design and population. Participants were recruited consecutively if (i) they were referred to colposcopy because of at least one ASC-US cytology, (ii) were Ն24 years old, and (iii) had not received treatment for CIN in the last 2 years. During the study period, HPV DNA testing was not widely available to primary care physicians in the study area and women were referred to colposcopy

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Section: Discussionsupporting

confidence: 54%

Human Papillomavirus (HPV) DNA Triage of Women with Atypical Squamous Cells of Undetermined Significance with Amplicor HPV and Hybrid Capture 2 Assays for Detection of High-Grade Lesions of the Uterine Cervix

et al. 2011

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“…Sarian et al 17 reported that women older than 35 years had a significantly higher risk of persistent infection following LEEP, while Costa et al 18 reported that age and high-grade Pap smear were both significant predictors of HPV clearance after conization. Some studies, however, have shown that age is not related to the persistence of HPV after treatment, which is consistent with our results.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with HPV persistence after conization in patients with negative margins

et al. 2009

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Objective: The clearance rate of human papillomavirus (HPV) after conization is generally high, although some HPV infections persist. We investigated the factors that affect the clearance of HPV after conization in patients with negative margins. Methods: We retrospectively analyzed 77 patients (mean age 39.9 years, range 25 to 51 years) with CIN 2/3 who underwent loop electrosurgical excision procedure (LEEP) conization with negative margins. All patients had a Pap smear and high-risk (HR) HPV testing using Hybrid Capture II system and HPV DNA chip before conization. We used≥1 relative light units (RLUs) as the cutoff for persistence of HPV after conization. Results: High-risk HPV was detected in 73 of 77 (94.8%) patients before conization. At the 6-months follow-up, the high-risk HPV was eliminated in 60 of 73 (82.2%) patients. The HPV persistence rate after conization was 17.8% (13/73). Univariate analysis showed that persistent HPV infection after conization with negative margins was more likely to occur when the pretreatment viral load was high (RLU/positive control ＞100 (p=0.027) and the HPV was type 16 (p=0.021). Logistic regression analysis showed that preoperative HPV type 16 infection was the only significant independent factor (p=0.021) for HPV persistence out of age, cytology, punch biopsy histology, HPV viral load, and conization histology. Conclusion: Conization effectively removes HR-HPV infection. HPV type 16 infection before conization was significantly related to HR-HPV persistence after conization with negative margins. Therefore, patients with HPV 16 infection before conization need to be followed closely.

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“…However, even women with clear margins following excision are at risk for disease recurrence (8). Carcinogenic human papillomavirus (HPV), the causative agent of cervical cancer and its precursor lesions, is present in up to one third of women following LEEP and is associated with disease recurrence (5,6,(9)(10)(11). Therefore, HPV testing may serve as a surveillance tool for identifying women at high risk of recurrence.…”

Section: Introductionmentioning

confidence: 99%

Human Papillomavirus Testing Following Loop Electrosurgical Excision Procedure Identifies Women at Risk for Posttreatment Cervical Intraepithelial Neoplasia Grade 2 or 3 Disease

Kreimer

Guido

Solomon

et al. 2006

Cancer Epidemiology, Biomarkers &Amp; Prevention

102

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Background: Loop electrosurgical excision procedure (LEEP) is the predominant treatment for cervical intraepithelial neoplasia grade 2 or 3 (CIN2+) in the United States, yet following treatment f10% of women are diagnosed again with CIN2+, necessitating close follow-up of such patients. Methods: Surveillance strategies using cytology and/or human papillomavirus (HPV) testing were compared among women who underwent LEEP (n = 610) in the Atypical Squamous Cells of Undetermined Significance (ASCUS) Low-Grade Squamous Intraepithelial Lesion (LSIL) Triage Study. Cervical specimens, collected at 6-month visits for 2 years, were used for cytology, Hybrid Capture 2 (HC2) detection of carcinogenic HPVs, and PCR for genotyping of carcinogenic and noncarcinogenic HPV types. At exit, women had colposcopy for safety and disease ascertainment. Results: At the visit post-LEEP (median time: 4.5 months after LEEP), 36.9% [95% confidence interval (95% CI), 32.7-41.1%] of women were positive for carcinogenic HPV by PCR and 33.7% (95% CI, 29.7-37.9) had ASCUS or more severe (AS-CUS+) cytology. The overall 2-year cumulative incidence of histologically confirmed posttreatment CIN2+ was 7.0%; this could be further stratified by the HPV risk category detected

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Factors associated with HPV persistence after treatment for high-grade cervical intra-epithelial neoplasia with large loop excision of the transformation zone (LLETZ)

Cited by 73 publications

References 29 publications

Human Papillomavirus (HPV) DNA Triage of Women with Atypical Squamous Cells of Undetermined Significance with Amplicor HPV and Hybrid Capture 2 Assays for Detection of High-Grade Lesions of the Uterine Cervix

Human Papillomavirus (HPV) DNA Triage of Women with Atypical Squamous Cells of Undetermined Significance with Amplicor HPV and Hybrid Capture 2 Assays for Detection of High-Grade Lesions of the Uterine Cervix

Factors associated with HPV persistence after conization in patients with negative margins

Human Papillomavirus Testing Following Loop Electrosurgical Excision Procedure Identifies Women at Risk for Posttreatment Cervical Intraepithelial Neoplasia Grade 2 or 3 Disease

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