Follow-up after treatment of cervical intraepithelial neoplasia by human papillomavirus genotyping

Brismar, Sophia; Johansson, Bo; Borjesson, Malin; Arbyn, Marc; Andersson, Sonia

doi:10.1016/j.ajog.2009.01.005

Cited by 32 publications

(49 citation statements)

References 38 publications

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“…7,9,13,14 Most studies 11,15,16 show that recurrent/residual disease occurs virtually only in women with abnormal cytology and/ or a positive hrHPV test.…”

Section: 12mentioning

confidence: 99%

See 1 more Smart Citation

Type‐specific HPV geno‐typing improves detection of recurrent high‐grade cervical neoplasia after conisation

Heymans

Benoy²,

Poppe

et al. 2011

Intl Journal of Cancer

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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 CIN21 were identified. A group of women (n 5 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 genotyping is the most sensitive and specific method to predict recurrent or persistent CIN 2-3 in the next 24 months.There is now overwhelming evidence that a persistent infection with a high-risk human papillomavirus (hrHPV) is the key event in the development of cervical cancer and its precursor lesions, high-grade cervical intra-epithelial neoplasia (CIN 2).1-4 The diagnosis of high-grade CIN 2-3 carries a significant risk of developing invasive carcinoma if it is not detected early and left untreated.5 Conservative treatment with large loop excision of the transformation zone (LLETZ) or conisation is the standard procedure for high-grade CIN and usually results in a complete cure, but residual or recurrent disease still occurs on average in 10% of treated cases. 6 Most treatment failures occur during the first 2 years after surgery. Therefore, according to the current guidelines in most western countries, women who have been treated for CIN2þ, afterward remain under gynaecological surveillance, with cervical smears taken at 6, 12 and 24 months post-treatment.7 Later, they are seen annually until the last two smears read as normal.Various studies have investigated potential predictive factors to identify the women at risk for recurrent disease. These factors include size of the lesion, grade of dysplasia, age, incomplete removal of the lesion and immunosuppressive therapy. 8-11Since persistent cervical infection with hrHPV has been iden...

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“…7,9,13,14 Most studies 11,15,16 show that recurrent/residual disease occurs virtually only in women with abnormal cytology and/ or a positive hrHPV test.…”

Section: 12mentioning

confidence: 99%

“…11,12 Recently, new studies have documented higher sensitivity and better negative predictive value for HPV DNA testing than for follow-up cytology after CIN treatment. 7,9,13,14 Most studies 11,15,16 show that recurrent/residual disease occurs virtually only in women with abnormal cytology and/ or a positive hrHPV test.…”

mentioning

confidence: 99%

Type‐specific HPV geno‐typing improves detection of recurrent high‐grade cervical neoplasia after conisation

Heymans

Benoy²,

Poppe

et al. 2011

Intl Journal of Cancer

View full text Add to dashboard Cite

show abstract

“…Women who have been treated for CIN are considered to be at high-risk of developing invasive cervical cancer for many years after treatment, necessitating a long-term followup strategy to detect residual/recurrent CIN. Compared to cytology, HPV DNA testing allows quicker identification of residual/recurrent CIN (15)(16)(17)(18), and has high sensitivity and negative predictive value (NPV) (18).…”

Section: Introductionmentioning

confidence: 99%

High-risk human papillomavirus E6/E7 mRNA and L1 DNA as markers of residual/recurrent cervical intraepithelial neoplasia

et al. 2012

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Abstract. The aim of this study was to assess the use of human papillomavirus (HPV) E6/E7 mRNA testing in the follow-up of women treated for cervical intraepithelial neoplasia (CIN) by conization and to compare the prognostic value of HPV E6/E7 mRNA to HPV L1 DNA and cytology. One hundred and forty-three women underwent cytological/histological testing, HPV DNA genotyping by Linear Array, and HPV E6/ E7 mRNA testing by APTIMA HPV assay during followup after surgical treatment for histologically verified CIN. High-grade residual/recurrent disease (CIN2 + /HSIL + ) was identified in 7 (4.9%) women, and low-grade disease (CIN1/ LSIL) in 25 (17.5%). At the inclusion visit 33 (23%) women were HPV DNA-positive; 13 (9.0%) were HPV E6/E7 mRNApositive. HPV E6/E7 mRNA did not identify three women with high-grade disease. Presence of high-risk HPV DNA at the inclusion visit predicted 100% (95% CI 64.6-100) of high-grade residual/recurrent disease, with a specificity of 80.9% (95% CI 73.5-86.6); cytology had a sensitivity of 85.7%, and a specificity of 87.5%. HPV E6/E7 mRNA testing was a poor predictor of treatment failure, with a sensitivity of 57.1% (95% CI 25.0-84.2), but high specificity (93.4%; 95% CI 87.9-96.5). Detection of high-risk HPV DNA after treatment by conization identified 100% of women with residual/recurrent high-grade disease, whereas HPV E6/E7 mRNA testing was a poor predictor of treatment failure. This study suggests that a negative HPV mRNA result cannot exclude the risk of malignant progression, and that HPV E6/E7 mRNA testing by APTIMA HPV assay is not useful in the follow-up of women treated for CIN.

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“…In recent years, instead of cocktail based HR-HPV DNA, tests prioritizing HPV genotyping became popular (11,(20)(21)(22). Detection of same HPV type after LEEP, and especially persistence of some HPV types such as 16 and 18 are mentioned to be at most importance (11,20).…”

Section: Discussionmentioning

confidence: 99%

Determination of Recurrent/Residual Cin-Ii and Cin-Iii After Leep. Cytology or HPV-Dna?

Çoban

Durukan

Dilek

et al. 2016

ZKTB

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Follow-up after treatment of cervical intraepithelial neoplasia by human papillomavirus genotyping

Cited by 32 publications

References 38 publications

Type‐specific HPV geno‐typing improves detection of recurrent high‐grade cervical neoplasia after conisation

Type‐specific HPV geno‐typing improves detection of recurrent high‐grade cervical neoplasia after conisation

High-risk human papillomavirus E6/E7 mRNA and L1 DNA as markers of residual/recurrent cervical intraepithelial neoplasia

Determination of Recurrent/Residual Cin-Ii and Cin-Iii After Leep. Cytology or HPV-Dna?

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