HPV testing in the follow-up after treatment of women with CIN

Department of Gynecologic Oncology, Charité Universitätsmedizin Berlin, Campus Mitte und Benjamin Franklin, Germany Hindenburgdamm 30, 12200 Berlin.
Gynecologic Oncology (Impact Factor: 3.77). 11/2007; 107(1 Suppl 1):S5-7. DOI: 10.1016/j.ygyno.2007.07.048
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Available from: Andreas M Kaufmann
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    ABSTRACT: Although effective strategies for preventing cancer of the uterine cervix exist, this disease continues to be a serious health problem worldwide, especially in developing countries. Today, the role of human papillomavirus (HPV) as a causal factor for the emergence of cervical cancer and its precursor lesions is well established, and prevention programs against cervical cancer are based on detecting cervical intraepithelial neoplasia (CIN). HPV present immunological evasion mechanisms that inhibit detection of the virus by the host, which may result in persistent chronic infection and irrevocably comprise the host defenses. Conization is the surgical technique most used for treating high-grade CIN, since it makes it possible to exclude invasive neoplasia, evaluate resection margins and preserve fertility. However, several factors have been considered to be indicators for residual disease. This review had the aim of covering some factors relating to persistence and recurrence of high-grade CIN following conization.
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    ABSTRACT: The clearance rate of human papillomavirus (HPV) after conization is generally high, although some HPV infections persist. We investigated the factors that affect the clearance of HPV after conization in patients with negative margins. We retrospectively analyzed 77 patients (mean age 39.9 years, range 25 to 51 years) with CIN 2/3 who underwent loop electrosurgical excision procedure (LEEP) conization with negative margins. All patients had a Pap smear and high-risk (HR) HPV testing using Hybrid Capture II system and HPV DNA chip before conization. We used>/=1 relative light units (RLUs) as the cutoff for persistence of HPV after conization. High-risk HPV was detected in 73 of 77 (94.8%) patients before conization. At the 6-months follow-up, the high-risk HPV was eliminated in 60 of 73 (82.2%) patients. The HPV persistence rate after conization was 17.8% (13/73). Univariate analysis showed that persistent HPV infection after conization with negative margins was more likely to occur when the pretreatment viral load was high (RLU/positive control >100 (p=0.027) and the HPV was type 16 (p=0.021). Logistic regression analysis showed that preoperative HPV type 16 infection was the only significant independent factor (p=0.021) for HPV persistence out of age, cytology, punch biopsy histology, HPV viral load, and conization histology. Conization effectively removes HR-HPV infection. HPV type 16 infection before conization was significantly related to HR-HPV persistence after conization with negative margins. Therefore, patients with HPV 16 infection before conization need to be followed closely.
    Preview · Article · Jun 2009 · Journal of Gynecologic Oncology
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    ABSTRACT: The aim of study was to investigate factors predicting persistence or relapse of disease after cervical conisation for high-grade squamous intraepithelial lesions (CIN 2 or 3). The study involved 78 women with high-grade squamous intraepithelial lesions, conservatively treated with loop electroexcision procedure for cervical conisation and subsequent with CO(2) laser-vaporisation of the cervical bed. Histological specimens were totally included and examined by an experienced pathologist. To evaluate the efficacy of treatment, the patients were examined with colposcopy and Pap smear 4 months after surgery and with PCR to search for and genotyping of HPV, 10 months after treatment. During the post-treatment follow-up, the cytologic examination showed persistent/relapsing disease in six patients (7.6%). In only 1 case, the deep margin of the cone was considered positive for CIN (16%).Ten months after treatment, viral typing revealed the persistence of high-risk HPV in all of these patients. Conversely, the viral follow-up of the other 72 patients without persisting/relapsing disease after treatment disclosed low-risk HPV genotypes in 6 cases, high-risk HPV in 2 cases (2.7%), whereas 7 cases had positive margins for CIN (9.7%). The risk of persistence and relapse of CIN in the group with positive margins was not statistically significant (P = 0.87), whereas it was in the group with HR-HPV positive (P = 0.000048). HPV testing is the most sensitive mean of identifying persistence or relapse early and is therefore capable of optimising follow-up after the treatment of high-grade CIN.
    No preview · Article · Dec 2009 · Archives of Gynecology
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