Role of human papillomavirus status after conization for high‐grade cervical intraepithelial neoplasia

Abstract

Human papillomavirus (HPV) is the well‐established etiologic factor for cervical neoplasia. Cervical conization constitutes an effective treatment for high‐grade cervical intraepithelial neoplasia (HG‐CIN). We conducted an observational study for long‐term outcomes and HPV genotype changes after conization for HG‐CIN. Between 2008 and 2014, patients with newly diagnosed HG‐CIN before conization (surveillance new [SN] group) and those who had undergone conization without hysterectomy (surveillance previous [SP] group) were enrolled. HPV testing and Pap smear were performed periodically for the SN and SP (collectively S) groups. All other patients receiving conization for HG‐CIN during the study period were identified from our hospital database. Those eligible but not enrolled into our study were assigned to the non‐surveillance (non‐S) group. For the S group (n = 493), the median follow‐up period was 74.3 months. Eighty‐four cases had recurrent CIN Grade 2 or worse (CIN2+) (5‐year cumulative rate: 14.8%), of which six had invasive cancer. Among the 84 patients, 65 (77.4%) exhibited type‐specific persistence in the paired HPV results, whereas only 7 (8.3%) harbored new HPV types that belonged to the 9‐valent vaccine types. Among the 7397 non‐S patients, 789 demonstrated recurrent CIN2+, of which 57 had invasive cancer. The stages distribution of those progressed to invasive cancer in the non‐S group were more advanced than the S group (P = .033). Active surveillance might reduce the severity of those progressed to cancer. Because a majority of the patients with recurrent CIN2+ had persistent type‐specific HPV infections, effective therapeutic vaccines are an unmet medical need.

HPV conversion rates after LEEP, cold-knife conization, and laser and drug therapy: A 4-year follow-up study

“…Close follow-up is recommended for patients with glandular involvement, older age, large BMI to prevent recurrence and disease progression. [20,21] In our study, among the 10 laser-treated patients, one case with multiple high-risk HPV infections (types 16, 51, and 31) was hospitalized for radical cervical cancer surgery after 2 years of laser treatment, with TCT suggesting HSIL and cervical pathology biopsy suggesting cervical cancer.…”

High Prevalence of Non-Vaccinated Oncogenic Human Papillomavirus Genotypes in High-Grade Squamous Intraepithelial Lesions of the Cervix: Thought-Provoking Results of a Detailed HPV Genotype Analysis

“…Cervical conization is an effective treatment for HSIL, however, this treatment cannot eradicate high-risk HPV; a wide range of recurrence rates of HSIL after conization (0.35–69%) was reported, hence close follow-up of the patients is crucial [ 26 , 28 , 29 ]. Unfortunately, there is no consensus regarding the optimal follow-up and frequency of control examinations of patients in the post-treatment period.…”

Current Updates on Cancer-Causing Types of Human Papillomaviruses (HPVs) in East, Southeast, and South Asia

“…The other most prevalent hrHPV genotypes include HPV31 (1.37–8.89%), HPV33 (0.74–9.1%), HPV35 (0.5–3.2%), HPV39 (0.7–13.33%), HPV45 (0.8–9.1%), HPV51 (0.3–18.8%), HPV52 (1.08–40.74%), HPV56 (0.2–9%), HPV58 (1.9–15.6%), HPV59 (0.6–4.4%), and HPV68 (0.4–11.11%) [ 56 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 ]. The HPV detection rate was also found to increase as lesions progress from precancerous (low-grade squamous intraepithelial (LSIL) at 48.12–91.5% and high-grade squamous intraepithelial lesion (HSIL) at 75.6–99.5%) to cancerous (invasive cervical cancer (ICC) at 64.3–100%) [ 56 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 ]. The detailed prevalence of hrHPV genotypes detected in different stages of cervical lesions by regions and countries is summarized in Table 1 .…”

“…The hrHPV genotypes that are most frequently detected in cervical lesions are HPV16, 18,31,33,35,39,45,51,52,56,58,59, and 68 [61][62][63][64][65][66][67][68][69][70][71]. As previously mentioned, the HPVpositive rate has been found to increase as lesions progress from low grade (LSIL) (78.2-85.8%) and HSIL (75.6-100%)) to high grade (ICC (64.3-100%)) lesions.…”