HPV testing in the context of post-treatment follow up (test of cure)

Cuschieri, Kate; Bhatia, Ramya; Cruickshank, Margaret; Hillemanns, Peter; Arbyn, Marc

doi:10.1016/j.jcv.2015.10.008

Cited by 48 publications

(64 citation statements)

References 51 publications

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“…This prioritization suggests that HR-HPV testing is optimal for post-treatment follow-up. Consistent with the inclusion of HR-HPV testing for post-treatment follow-up in several high-resource countries (summarized here[18]), we found HR-HPV was the most sensitive test for CIN2+ detection in our sub-Saharan African setting. Capacity for molecular testing is increasing[19, 20], and HPV testing in this smaller subpopulation may be more feasible than in general screening, where the number false positive tests that require triage might overwhelm the health system or result in unnecessary procedures.…”

Section: Discussionsupporting

confidence: 87%

Use of visual inspection with acetic acid, Pap smear, or high-risk human papillomavirus testing in women living with HIV/AIDS for posttreatment cervical cancer screening

Orang’o

Liu

Christoffersen-Deb

et al. 2017

Aids

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Objectives Few studies have addressed optimal follow-up for HIV-infected women after cervical treatment. This study aimed to compare performance of three available tests to detect post-treatment cervical disease in HIV-infected women in Kenya. Design This is a prospective cohort study. Methods At least six months following cryotherapy, 517 HIV-infected women were evaluated concurrently with VIA, Pap smear, and HR-HPV testing. Women positive by any test (≥LSIL for Pap) were scheduled for colposcopy and biopsy. Among 248 with histological confirmation (and 174 assumed to be truly negative for CIN2+ after testing negative by all three tests), the ability of each test alone, or in combination, to detect CIN2+ was calculated to determine their utility in post-treatment follow-up. Results The median age of women was 35 years, 68% were WHO stage 1–2, with a median CD4 count of 410 cells/uL, and 87% were on combination antiretroviral therapy. At a median of 6.3 months post-treatment, 64% had an abnormal screen by VIA, Pap, and/or HR-HPV. Among women with histological confirmation, 72 (30%) had persistent/recurrent CIN2+. As single tests, Pap correctly classified the most cases (83%) and had the highest specificity (91% (88%, 95%); sensitivity 44% (35, 53%)), whereas HR-HPV had the highest sensitivity (85% (75%, 96%); specificity 54% (49%, 58%)). VIA was not sensitive (27% (18%, 36%)) for the detection of post-treatment CIN2+ (specificity 82% (79%, 86%)). Conclusions With the goal to minimize the number of false negatives (e.g. not miss CIN2+ post-treatment) in this population that is high-risk due to both prior cervical disease and HIV infection, HR-HPV based algorithms are recommended.

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Section: Discussionsupporting

confidence: 87%

Use of visual inspection with acetic acid, Pap smear, or high-risk human papillomavirus testing in women living with HIV/AIDS for posttreatment cervical cancer screening

Orang’o

Liu

Christoffersen-Deb

et al. 2017

Aids

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“…[6][7][8] In order to clinically monitor patients post-CIN treatment, follow-up strategies recommended by the ASCCP include HPV testing, cytology and colposcopy, either alone or in combination, at either 3-month or annual intervals. Given the higher sensitivity of HPV testing for CIN 2-3 detection relative to cytology or colposcopy, 9,10 HPV testing is regularly utilized post-treatment in many clinical practices to aid in the early detection of recurrent CIN disease. 10 To date, there has been no summary of the literature that examines the estimates of and definitions for HPV persistence after CIN treatment.…”

mentioning

confidence: 99%

“…Given the higher sensitivity of HPV testing for CIN 2-3 detection relative to cytology or colposcopy, 9,10 HPV testing is regularly utilized post-treatment in many clinical practices to aid in the early detection of recurrent CIN disease. 10 To date, there has been no summary of the literature that examines the estimates of and definitions for HPV persistence after CIN treatment. In 2014, we published a systematic review of HPV incidence after treatment for CIN.…”

mentioning

confidence: 99%

Patterns of persistent HPV infection after treatment for cervical intraepithelial neoplasia (CIN): A systematic review

Hoffman¹,

Lockhart³

et al. 2017

Intl Journal of Cancer

107

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A systematic review of the literature was conducted to determine the estimates of and definitions for human papillomavirus (HPV) persistence in women following treatment of cervical intra-epithelial neoplasia (CIN). A total of 45 studies presented data on post-treatment HPV persistence among 6,106 women. Most studies assessed HPV persistence after loop excision (42%), followed by conization (7%), cryotherapy (11%), laser treatment (4%), interferon-alpha, therapeutic vaccination, and photodynamic therapy (2% each) and mixed treatment (38%). Baseline HPV testing was conducted before or at treatment for most studies (96%). Follow-up HPV testing ranged from 1.5 to 80 months after baseline. Median HPV persistence tended to decrease with increasing follow-up time, declining from 27% at 3 months after treatment to 21% at 6 months, 15% at 12 months, and 10% at 24 months. Post-treatment HPV persistence estimates varied widely and were influenced by patient age, HPV-type, detection method, treatment method, and minimum HPV post-treatment testing interval. Loop excision and conization appeared to outperform cryotherapy procedures in terms of their ability to clear HPV infection. This systematic review provides evidence for the substantial heterogeneity in post-treatment HPV DNA testing practices and persistence estimates.

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“…Molecular HPV testing is rapidly being introduced into cervical cancer screening and management of cytology-positive women [28,48] as it can provide both diagnostic and prognostic information for the clinical evaluation of at risk women. Several technical advances have begun to emerge for the molecular diagnosis of HPV DNA, although a number of these tests are in process of, or require, clinical validation for clinical screening purposes, essential in evaluating the characteristics and performance parameters including sensitivity and specificity [49], and/or the negative predictive value of an HPV test in high and changing HPV prevalence settings (i.e., due to HPV vaccines) [26].…”

Section: Hpv Testing Technologiesmentioning

confidence: 99%

Molecular tests potentially improving HPV screening and genotyping for cervical cancer prevention

Gradíssimo

Burk

2017

Expert Review of Molecular Diagnostics

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INTRODUCTION Human papillomavirus (HPV)-related cancers can be averted by type-specific vaccination (primary prevention) and/or through detection and ablation of precancerous cervical lesions (secondary prevention). This review presents current challenges to cervical cancer screening programs, focusing on recent molecular advances in HPV testing and potential improvements on risk stratification. AREAS COVERED High-risk (HR)-HPV DNA detection has been progressively incorporated into cervix cancer prevention programs based on its increased sensitivity. Advances in next-generation sequencing (NGS) are being rapidly applied to HPV typing. However, current HPV DNA tests lack specificity for identification of cervical precancer (CIN3). HPV typing methods were reviewed based on published literature, with a focus on these applications for screening and risk stratification in the emerging complex clinical scenario post-vaccine introduction. In addition, the potential for NGS technologies to increase specificity is discussed in regards to reflex testing of specimens for emerging biomarkers for cervix precancer/cancer. EXPERT COMMENTARY Integrative multi-disciplinary molecular tests accurately triaging exfoliated cervical specimens will improve cervical cancer prevention programs while simplifying healthcare procedures in HPV-infected women. Hence, the concept of a “liquid-biopsy” (i.e., “molecular” Pap test) highly specific for early identification of cervical precancerous lesions is of critical importance in the years to come.

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HPV testing in the context of post-treatment follow up (test of cure)

Cited by 48 publications

References 51 publications

Use of visual inspection with acetic acid, Pap smear, or high-risk human papillomavirus testing in women living with HIV/AIDS for posttreatment cervical cancer screening

Use of visual inspection with acetic acid, Pap smear, or high-risk human papillomavirus testing in women living with HIV/AIDS for posttreatment cervical cancer screening

Patterns of persistent HPV infection after treatment for cervical intraepithelial neoplasia (CIN): A systematic review

Molecular tests potentially improving HPV screening and genotyping for cervical cancer prevention

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