Long-term CIN3+ risk in women with abnormal cytology; role of hrHPV testing

Abstract

Background:Many studies have examined the short-term value of high-risk human papillomavirus (hrHPV) testing in predicting cumulative risk of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+). This study focuses on long-term CIN3+ risk after initial wait and see policy.Methods:A total of 342 women with abnormal cytology of borderline/mild dyskaryosis (BMD) or worse (>BMD), included between 1990 and 1992, were followed-up by cytology and hrHPV testing until 1996 and monitored by cytology thereafter. Primary endpoint was cumulative CIN3+ risk by December 2009.Results:Women with BMD had a 5-year CIN3+ risk of 22.5% (95% confidence interval (CI) 17.0–29.1) and of 0.7% (0.1–4.5) in the subsequent 5 years. High-risk human papillomavirus-negative women with BMD had a 5-year risk of <0.01% (95% CI 0.0–5.1) and of <0.01% (0.0–5.7) in the following 5 years, while for hrHPV-positive women these risks were 37.5% (29.0–46.9) and 1.6% (0.2–9.5), respectively. Women with >BMD had a 5-year risk of 45.1% (36.4–54.1) and of 3.5% (0.9–12.2) in the subsequent 5 years. High-risk human papillomavirus-negative women with >BMD had a 5-year risk of 7.3% (2.0–23.6) and hrHPV-positive women of 56.6% (46.4–66.3).Conclusion:Women with BMD have an elevated CIN3+ risk for 5 years only; afterwards their risk is similar to the general population. High-risk human papillomavirus-negative women with BMD may return to regular screening directly. All other women with ⩾BMD should be referred for additional testing and/or colposcopy.

Follow up with HPV test and cytology as test of cure, 6 months after conization, is reliable

“…Women treated for cervical dysplasia have an increased risk for recurrence compared with women without previous disease or treatment . According to the literature, this risk remains elevated for more than 10 years after treatment using repeat cytology for monitoring and test of cure .…”

“…The current literature , including a systematic review by Kocken et al. , emphasizes that women testing negative for high‐risk HPV and having negative cytology 6 months after conization may omit the 12‐month follow up with no, or only minimal, risk for HSIL or cervical cancer.…”

Triaging HPV‐positive women with normal cytology by p16/Ki‐67 dual‐stained cytology testing: Baseline and longitudinal data

“…Adjusted endpoints for HPV‐positive women with normal cytology were defined as ≤CIN1 when they had a normal cytological test result within 3 years of follow‐up. Alternatively, HPV‐positive women with normal cytology were considered to have CIN2+ when they had cytology test results categorized as moderate dyskaryosis or worse (≥BMD) during their follow‐up without any histological test result . Because of the unknown histological outcome these were only considered as CIN2+ and not as CIN3+.…”

Residual Disease and HPV Persistence after Cryotherapy for Cervical Intraepithelial Neoplasia Grade 2/3 in HIV-Positive Women in Kenya

“…Women living with HIV are at increased risk for infection with human papillomavirus (HPV), cervical intraepithelial neoplasia grade 2 or 3 (CIN2/3) and invasive cervical cancer [1] , [2] . Residual or recurrent disease after CIN2/3 treatment is also more frequent among HIV-positive women [3] than HIV-negative women [4] , [5] .…”

“…However, cryotherapy is more feasible and affordable than excisional treatment in low- and middle-income countries [16] . Little information is available on the efficacy of cryotherapy for the treatment of CIN2/3 in HIV-positive women [6] and none on the impact of cryotherapy on HPV persistence, i.e., a strong risk factor for residual/recurrent disease in HIV-negative women [4] , [5] .…”