Repeat conisation or HPV test? What should be done if histology of the primary conisation requires a second conisation?

Objective: In our retrospective study we focused on the sensitivity of HPV DNA testing towards reducing the number of repeat (re)conisations. Is the second HPV test (pre repeat conisation) an appropriate method to reduce the number of interventions in histologically positive cases? Study: 438 cervical conisations - loop electrosurgical excision procedure (LEEP) - were performed between March 2008 and August 2010 at our Gynaecology Department. Samples for high-risk HPV testing (Genoid, Hungary) were taken from the surface of the cervix and from the cervical canal before the LEEP procedure, and histopathological examinations were performed. Margin positivity was the indication for re-conisation (re-LEEP). Results: 119 (27.2%) out of 438 cases were re-conisations. In cases of histologically proven residual dysplasia (29 of 119) high-risk HPV infection was also detected by HPV testing. In 90 cases of 119 residual dysplasia was not seen by histological examination. In this high-risk group HPV infection had not been detected in 77 cases (85.5%) by the time the second HPV test was performed. HPV tests for high-risk types were positive only in 13 of 90(14.5%) without residual dysplasia. Furthermore the same HPV type was detected only in three cases taken before the first and second conisation procedure. Conclusion: Pre re-conisation HPV testing might be useful in reducing the number of re-conisations where the high-risk HPV test is either negative or does not confirm the previously proven HPV type.

HPV test; Repeat conisation; Screening cervical cancer, Prevention cervical cancer; Cervical intraepithelial neoplasia

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