Is high-risk human papillomavirus infection associated with cervical intraepithelial neoplasia eliminated after conization by large-loop excision of the transformation zone?

Kucera, E; Sliutz, Gerhard; Czerwenka, K.; Breitenecker, G.; Leodolter, Sepp; Reinthaller, Alexander

doi:10.1016/s0301-2115(01)00457-2

Cited by 53 publications

(38 citation statements)

References 24 publications

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“…1,2 However, CIN can recur, and invasive cervical carcinoma can develop, following such CIN treatment. The cumulative rate of invasion 8 years after CIN treatment is 5.8 per 1000 women, which is five times higher than for the general population.…”

Section: Introductionmentioning

confidence: 99%

“…However, these factors are suboptimal predictors, [4][5][6][7][8][9][10][11][12] and cannot be used to dictate the follow-up strategy after conization. While there is increasing evidence that testing for the presence of high risk-human papilloma virus (HR-HPV) after conization may help predict the likelihood of persistent or recurrent disease, 1,[13][14][15][16][17][18][19][20][21][22] no study has shown how HR-HPV testing might be integrated into post conization surveillance. The aim of this study was to determine whether HR-HPV test after conization is a predictive factor for CIN persistence or recurrence after LLETZ or CKC of the cervix.…”

Section: Introductionmentioning

confidence: 99%

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Role of high risk-human papilloma virus test in the follow-up of patients who underwent conization of the cervix for cervical intraepithelial neoplasia

Bae

Lim

et al. 2009

J Gynecol Oncol

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Objective: To examine whether the presence of high risk-human papilloma virus (HR-HPV) after conization of the cervix was a risk factor for persistence or recurrence of cervical intraepithelial neoplasia (CIN) and whether HR-HPV test could be a guideline for post-therapy surveillance. Methods:The study retrospectively analyzed data from 243 patients who underwent LLETZ or CKC of the cervix due to CIN. Results: A positive HR-HPV test result which was performed between 3 and 6 months after procedure was a risk factor for persistent or recurrent cytological (p＜0.001, odds ratio [OR]=22.51, 95% confidence interval [CI]= 9.74-52.02) and pathological (p＜0.001, OR=18.28, 95% CI=5.55-60.20) abnormalities. Conclusion: HR-HPV positive patients between 3 and 6 months after procedure should undergo frequent and meticulous post-therapy surveillance, while HR-HPV negative patients do not require such high-level surveillance and could undergo routine surveillance.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Role of high risk-human papilloma virus test in the follow-up of patients who underwent conization of the cervix for cervical intraepithelial neoplasia

Bae

Lim

et al. 2009

J Gynecol Oncol

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“…[34][35][36][37] However, although we found at initial colposcopy that the frequency of CIN2 or worse was higher in the immediate LLETZ arm than in the biopsy and recall arm (37% versus 27%), this does not justify a policy of immediate LLETZ in hrHPV+ve women with an abnormal TZ, because there was no significant difference in cumulative incidence of CIN2 or worse (or CIN3 or worse) at 3 years. Furthermore, younger age is associated both with hrHPV infection and an abnormal TZ.…”

Section: Potential Role Of Hpv Testing: Implications Of Our Resultsmentioning

confidence: 99%

“…4 Excisional treatment, including LLETZ, appears to eliminate most HPV infection. [34][35][36][37] Therefore, the presence of HPV infection might influence the comparative effectiveness of these alternative treatment strategies. This has not previously been investigated in an RCT.…”

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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“…Não se sabe entretanto, se a detecção do DNA-HPV após o tratamento da NIC, pode ser utilizada como fator clí-nico preditivo de persistência ou recidiva da doença. Muitos autores acreditam que a detecção do DNA-HPV ajuda a selecionar as mulheres que apresentarão recidiva, porém outros não verificaram associação entre a detecção viral e a presença de doença residual ou recorrente [9][10][11][12][13][14][15] .…”

Section: Introductionunclassified

Detecção do DNA do papilomavírus humano após excisão da zona de transformação com alça diatérmica para tratamento de neoplasia intra-epitelial cervical

Figueirêdo¹,

Derchain²,

Sarian³

et al. 2003

Rev. Bras. Ginecol. Obstet.

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RESUMO Objetivo: avaliar a presença do DNA do papilomavírus humano (HPV) de alto risco oncológico antes e quatro meses após excisão da zona de transformação com alça diatérmica em mulheres com neoplasia intra-epitelial cervical (NIC (OR = 4,8; IC 95% = 1,(7)(8)(9)(10)(11)(12)(13)7), porém não se relacionou com doença residual ou recidiva histológica (OR = 6,0; IC 95% = 0,3 IntroduçãoA excisão da zona de transformação com alça diatérmica é hoje uma das técnicas cirúrgicas mais utilizadas para o diagnóstico e tratamento da neoplasia intra-epitelial cervical (NIC). Existe correlação entre o comprometimento das margens da peça cirúrgica e a freqüência de doença residual e de recidiva. Porém, se 30% das mulheres com margens comprometidas apresentam doença residual no colo restante, 8% daquelas com margens livres, também apresentem doença residual ou recidiva 1-3 . Assim, atualmente, se tem optado pelo seguimento das mulheres submetidas à conização por NIC independentemente do comprometimento das margens do cone, com a coleta de colpocitologia oncológica (CO) e realização de colposcopia. Porém, um grande impulso vem sendo dado às pesquisas que possam identificar um novo marcador de recidiva após a conização [4][5][6] .Está bem estabelecido o papel do papiloma-

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Is high-risk human papillomavirus infection associated with cervical intraepithelial neoplasia eliminated after conization by large-loop excision of the transformation zone?

Cited by 53 publications

References 24 publications

Role of high risk-human papilloma virus test in the follow-up of patients who underwent conization of the cervix for cervical intraepithelial neoplasia

Role of high risk-human papilloma virus test in the follow-up of patients who underwent conization of the cervix for cervical intraepithelial neoplasia

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

Detecção do DNA do papilomavírus humano após excisão da zona de transformação com alça diatérmica para tratamento de neoplasia intra-epitelial cervical

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