Posttreatment Assessment of Women at Risk of Developing High-Grade Cervical Disease

Abstract

We propose a new posttreatment surveillance protocol, consisting of combined testing with both cytology and hrHPV at 6 and 24 months after treatment. After 2 negative cotesting results, women should be retested after 5 years.

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

“…The potential for verification bias in our study, which can exaggerate the sensitivity of a test, is likely very minimal since only those women negative by all three tests were not referred to histology. Furthermore, our results are consistent with the literature, including a large study in the Netherlands reporting the same 95% sensitivity for HR-HPV and Pap co-testing in post-treatment follow-up for CIN2+[24]. …”

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

“…Women with negative co‐testing after treatment have been shown to have a 5‐year risk for CIN grade 2 + of 1.0% (95% CI 0.2–4.6) and a 10‐year risk of 3.6% (95% CI 1.1–10.7). Furthermore, the 5‐year risk of CIN3 or invasive cancer has been reported to be 0.0% (95% CI 0.0–3.0) and the 10‐year risk, 0.0% (95% CI 0.0–5.3) . The current literature , including a systematic review by Kocken et al.…”

The value of endocervical curettage during loop electrosurgical excision procedures in predicting persistent/recurrent preinvasive cervical disease

“…Regarding the use of co‐testing as a follow‐up strategy, the available evidence seems to support its inclusion as a test of cure and as a more sensitive method for the detection of persistent or recurrent disease. The decision to use more frequent cytology‐based follow‐up instead of co‐testing, with the use of further assessment in the event of an abnormal cytology result, could have resulted in an underestimation of the rate of CIN2+ persistence/recurrence.…”