Prediction of Recurrent and Residual Cervical Dysplasia by Human Papillomavirus Detection among Patients with Abnormal Cytology

Bollen, Liesbeth J. M.; Tjong-A-Hung, Steven P.; Velden, J. van der; Mol, Ben Willem J.; Kate, Fiebo W.J. Ten; Schegget, Jan ter; Bleker, O. P.

doi:10.1006/gyno.1998.5250

Cited by 75 publications

(51 citation statements)

References 15 publications

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“…Smears were cytomorphologically classified as Pap 1 (normal), Pap 2 (very mild dyskaryosis), Pap 3a (mild to moderate dyskaryosis), Pap 3b (severe dyskaryosis), Pap 4 (suspected of carcinoma in situ) and Pap 5 (suspected of at least micro-invasive carcinoma). According to the guidelines, colposcopic examination including sampling for histological verification of suspect lesions was only performed in case of a cytomorphologically abnormal smear (≥ Pap 3a, mild dyskaryosis or worse) (Heintz, 1995;Helmerhorst and Wijnen, 1998;Bollen et al, 1999). All histological samples were reviewed by an expert pathologist who was unaware of the clinical findings.…”

Section: Cervical Cytology and Hpv Testingmentioning

confidence: 99%

Addition of high-risk HPV testing improves the current guidelines on follow-up after treatment for cervical intraepithelial neoplasia

et al. 2001

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We assessed a possible role for high-risk human papillomavirus (HPV) testing in the policy after treatment for cervical intraepithelial neoplasia (CIN) 2 or 3 (moderate to severe dysplasia). According to the Dutch guidelines follow-up after treatment consists of cervical cytology at 6, 12 and 24 months. Colposcopy is only performed in case of abnormal cervical cytology. In this observational study 184 women treated for CIN 2 or 3 were prospectively monitored by cervical cytology and high-risk HPV testing 3, 6, 9, 12 and 24 months after treatment. Post-treatment CIN 2/3 was present in 29 women (15.8%). A positive high-risk HPV test 6 months after treatment was more predictive for post-treatment CIN 2/3 than abnormal cervical cytology (sensitivity 90% and 62% respectively, with similar specificity). At 6 months the negative predictive value of a high-risk HPV negative, normal smear, was 99%. Largely overlapping, partly different groups of women with post-treatment CIN 2/3 were identified by HPV testing and cervical cytology. Based on these results we advocate to include high-risk HPV testing in monitoring women initially treated for CIN 2/3. In case of a high-risk HPV positive test or abnormal cervical cytology, colposcopy is indicated. All women should be tested at 6 and 24 months after treatment and only referred to the population-based cervical cancer screening programme when the tests are negative on both visits. © 2001 Cancer Research Campaign http://www.bjcancer.com

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Section: Cervical Cytology and Hpv Testingmentioning

confidence: 99%

Addition of high-risk HPV testing improves the current guidelines on follow-up after treatment for cervical intraepithelial neoplasia

et al. 2001

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“…[10][11][12] It is assumed that effective treatment for CIN lesions results in clearance of the hrHPV DNA, while in residual/recurrent CIN disease hrHPV infection is still present. 4,8,9,13 Currently, only cytology is used in the follow-up after treatment. Previous studies have established the value of hrHPV testing for detection of high-grade CIN lesions.…”

mentioning

confidence: 99%

“…Previous studies have established the value of hrHPV testing for detection of high-grade CIN lesions. 4,8,[14][15][16] The use of combined testing by cytology and hrHPV can lead to a better selection of women at risk for residual/recurrent CIN after initial treatment for high-grade CIN lesions. This has been confirmed in several retrospective and observational studies.…”

mentioning

confidence: 99%

Post‐treatment CIN: Randomised clinical trial using hrHPV testing for prediction of residual/recurrent disease

Bais

Eijkemans

Snijders

et al. 2008

Intl Journal of Cancer

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We investigated in a randomised clinical trial whether addition of hrHPV testing (high-risk human papillomavirus) to cytological follow-up after treatment for high-grade CIN (cervical intraepithelial neoplasia 2/3) can lead to a better selection of women at risk for residual/recurrent CIN. We included 210 women with high-grade CIN undergoing treatment in outpatient clinics in The Netherlands. Follow-up was based on cytology alone and cytology combined with hrHPV detection. Our primary outcome measurement was improving specificity for residual/recurrent CIN after treatment. Secondary, we compared health-care costs and impact of individual hrHPV type on the risk of residual/recurrent CIN. Follow-up by abnormal cytology alone (6, 12 and 24 months after treatment according to the Dutch protocol) showed a lower specificity for detection of residual/recurrent CIN than follow-up by abnormal cytology and presence of hrHPV (80 vs. 91%, relative risk 0.87 (95% CI 0.77-0.99)). Both methods showed no significant difference in sensitivity ((86 vs. 100%) RR 0.86 (95% CI 0.63-1.16)). Comparing different post hoc modifications in the strategy of combined testing showed similar test characteristics when lowrisk women (normal cytology and hrHPV negative at 6 months) omitted the 12 months visit (specificity 91%, p 5 1.00 z 5 0.00). Prediction of residual/recurrent CIN by typing of hrHPV could not be confirmed. Total health-care costs using cytology and hrHPV testing during follow-up decreased when low-risk women omit the 12 months visit. Follow-up after treatment for high-grade CIN can be improved by combining cytology with hrHPV testing. We advise combined cytology and hrHPV testing at 6, 12 and 24 months after treatment. Low-risk women may omit the 12 months visit, resulting in cost reduction. ' 2008 Wiley-Liss, Inc.Key words: cervical intraepithelial neoplasia; human papillomavirus; residual/recurrent CIN; RCT According to current Dutch standards, follow-up after treatment for high-grade CIN (cervical intraepithelial neoplasia 2/3) consists of cervical cytological monitoring at 6, 12 and 24 months, to identify residual/recurrent CIN lesions (CIN 2/3).1 Colposcopic examination is performed where there is abnormal cervical cytology. In case of normal cytology after 24 months, follow-up will be performed within the national screening program. One of the drawbacks of cervical cytological follow-up after treatment is the high number of false-positive findings. Approximately 20% of the women have abnormal cervical cytology within the first 2 years of follow-up. However, in more than half of these women no underlying residual/recurrent CIN will be found, resulting in unnecessary diagnostic and therapeutic procedures.2-6 The reported residual/recurrent high-grade CIN rates vary between 5 and 35%. 2,3,[7][8][9] A persistent infection with high-risk human papillomavirus (hrHPV) is necessary for the development, maintenance and progression of primary CIN lesions. [10][11][12] It is assumed that effective treatment for CIN lesions results...

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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

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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.

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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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Prediction of Recurrent and Residual Cervical Dysplasia by Human Papillomavirus Detection among Patients with Abnormal Cytology

Cited by 75 publications

References 15 publications

Addition of high-risk HPV testing improves the current guidelines on follow-up after treatment for cervical intraepithelial neoplasia

Addition of high-risk HPV testing improves the current guidelines on follow-up after treatment for cervical intraepithelial neoplasia

Post‐treatment CIN: Randomised clinical trial using hrHPV testing for prediction of residual/recurrent disease

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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