Human papillomavirus combined with cytology and margin status identifies patients at risk for recurrence after conization for high-grade cervical intraepithelial neoplasia

Objective: To compare the ability of cytology, human papillomavirus (HPV) testing and co-testing to identify recurrence of patients treated by loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia (CIN) 2-3. Materials and Methods: Retrospective analysis (R.A.): the medical records of 372 women treated for CIN 2-3 were reviewed. Resection margin, HPV typing, Pap smears, and biopsies post-LEEP were collected. Prospective analysis (P.A.): 97 women were followed post-LEEP by cytology, HPV test and colposcopy every six months. Results: Positive margins were found to be an independent risk factor for recurrent disease (OR0.192; 95% CI 0.074-0.497 in R.A. and OR 0.096; 95% CI 0.023-0.392 in P.A.). HPV testing showed less sensitivity than cytology (69% vs 84%, respectively in R.A. and 80% vs 100% in P.A.). Co-testing predicted recurrent disease at a sensitivity of 90.6% in R.A. and 100% in P.A. Conclusion: Co-testing is the best option in follow-up protocols after treatment for CIN 2-3. If margins are free and co-testing is negative at six and 12 months, 18 months visit could be avoided.

Human papillomavirus; Conization; Cervical intraepithelial neoplasia; Surveillance; Recurrence.

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