Article Data

  • Views 352
  • Dowloads 163

Systematic reviews

Open Access Special Issue

Development of evidence-based guidelines for follow up of women treated for cervical intraepithelial neoplasia grade 2 or 3 (CIN2/3) in Italian screening programmes

  • Paolo Giorgi Rossi1,*,
  • Anna Iossa2
  • Carmen Beatriz Visioli2
  • Francesco Venturelli1
  • Paola Garutti3

1Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy

2Screening and Secondary prevention Unit, Institute for Cancer Research, Prevention and Clinical Network, 50139 Florence, Italy

3Department of Obstetrics and Gynecology, University Hospital, Via Aldo Moro, 8, 44124 Cona, Ferrara, Italy

DOI: 10.31083/j.ejgo4205157 Vol.42,Issue 5,October 2021 pp.1079-1092

Submitted: 26 April 2021 Accepted: 29 June 2021

Published: 15 October 2021

(This article belongs to the Special Issue Update on Cervical Cancer Prevention and Screening)

*Corresponding Author(s): Paolo Giorgi Rossi E-mail: paolo.giorgirossi@ausl.re.it

Abstract

Background: The Italian Group for Cervical Cancer Screening (GISCi) promoted the update of recommendations for post Cervical Intraep-ithelial Neoplasia grade 2 or 3 (CIN2/3) treatment follow up. Methods: A multidisciplinary panel including all the professionals involved in cervical cancer screening and CIN treatment was set up. Systematic reviews have been conducted searching in PubMed. The GRADEpro online tool was used for: defining and prioritizing clinical questions framed in PICOs (Population Intervention Comparator Outcomes); defining and scoring outcomes as critical, important or not impor-tant; synthetizing results of the systematic reviews in Evidence to Decision tables and to grade recommendations. Results: A systematic review identified the main prognostic factors, but these have almost no impact in HPV-negative women. Six questions were prioritized for the first phase: 3 about the test (Pap, HPV-DNA or Pap + HPV co-testing or co-testing + colposcopy); 1 about the number of episodes before returning to screening; 2 about the timing of episodes. For the test accuracy direct evidence was available, while for other questions mostly indirect evidence was retrieved in systematic reviews. Conclusions: The panel recommends HPV test or co-testing (conditional either the two), but not Pap test as follow up test (strong). Colposcopy can be added to assess surgical outcomes (conditional either yes or not). Two episodes instead of one, before referring women to regular screening, should be preferred (conditional). The first episode should be 6 months (vs. 12) after treatment (strong), in order to avoid progression of undiagnosed prevalent invasive cancers; the interval between first and second episode may be either 6 or 12 months (conditional).


Keywords

Cervical cancer; Cervical intraepithelial neoplasia (CIN) grade 2 or grade 3; Post-treatment follow up; Test of cure; Human papillomavirus; Guidelines; Evidence-based medicine


Cite and Share

Paolo Giorgi Rossi,Anna Iossa,Carmen Beatriz Visioli,Francesco Venturelli,Paola Garutti. Development of evidence-based guidelines for follow up of women treated for cervical intraepithelial neoplasia grade 2 or 3 (CIN2/3) in Italian screening programmes. European Journal of Gynaecological Oncology. 2021. 42(5);1079-1092.

References

[1] IARC. IARC Handbooks of Cancer Prevention Volume 10. 2005. Available at: https://publications.iarc.fr/Book-And-Report-Ser ies/Iarc-Handbooks-Of-Cancer-Prevention/Cervix-Cancer-Scr eening-2005 (Accessed: 27 June 2021).

[2] WHO Guidelines. Guidelines for Screening and Treatment of Precancerous Lesions for Cervical Cancer Prevention. World Health Organization, Geneva. 2013. Available at: https://www.who.int/reproductivehealth/publications/canc ers/screening_and_treatment_of_precancerous_lesions/en/ (Accessed: 16 April 2021).

[3] Kyrgiou M, Athanasiou A, Paraskevaidi M, Mitra A, Kalliala I, Martin-Hirsch P, et al. Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis. British Medical Journal. 2016; 354: i3633.

[4] Bruni L, Albero G, Serrano B, Mena M, Gómez D, Muñoz J, et al. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in Italy. Summary Report. 2019. Available at: https://hpvcentre. net/statistics/reports/ITA.pdf?t=1630341031381 (Accessed: 10 May 2021).

[5] Rossi PG, Ricciardi A, Cohet C, Palazzo F, Furnari G, Valle S, et al. Epidemiology and costs of cervical cancer screening and cervical dysplasia in Italy. BMC Public Health. 2009; 9: 71.

[6] Arbyn M, Redman CWE, Verdoodt F, Kyrgiou M, Tzafetas M, Ghaem-Maghami S, et al. Incomplete excision of cervical precancer as a predictor of treatment failure: a systematic review and meta-analysis. The Lancet Oncology. 2017; 18: 1665–1679.

[7] Confortini M, Bulgaresi P, Cariaggi MP, Carozzi FM, Cecchini S, Cipparrone I, et al. Conventional Pap Smear and Liquidbased Cervical Cytology Smear: Comparison from the same Patient. Tumori Journal. 2002; 88: 288–290.

[8] Cecchini S, Carozzi F, Confortini M, Zappa M, Ciatto S. Persistent Human Papilloma Virus Infection as an Indicator of Risk of Recurrence of High-Grade Cervical Intraepithelial Neoplasia Treated by the Loop Electrosurgical Excision Procedure. Tumori Journal. 2004; 90: 225–228.

[9] Del Mistro A, Matteucci M, Insacco EA, Onnis G, Da Re F, Baboci L, et al. Long-Term Clinical Outcome after Treatment for High-Grade Cervical Lesions: a Retrospective Monoinstitutional Cohort Study. BioMed Research International. 2015; 2015: 984528.

[10] Strander B, Hällgren J, Sparén P. Effect of ageing on cervical or vaginal cancer in Swedish women previously treated for cervical intraepithelial neoplasia rade 3: population based cohort study of long term incidence and mortality. British Medical Journal. 2014; 348: f7361.

[11] Rebolj M, Helmerhorst T, Habbema D, Looman C, Boer R, van Rosmalen J, et al. Risk of cervical cancer after completed post-treatment follow-up of cervical intraepithelial neoplasia: population based cohort study. British Medical Journal. 2012; 345: e6855–e6855.

[12] Pan J, Kavanagh K, Cuschieri K, Pollock KG, Gilbert DC, Millan D, et al. Increased risk of HPV‐associated genital cancers in men and women as a consequence of pre‐invasive disease. International Journal of Cancer. 2019; 145: 427–434.

[13] Official Journal of the European Union. Council Recommendation of 2 December 2003 on cancer screening. 2003/878/EC. 2003. Available at: https://ec.europa.eu/jrc/sites/jrcsh/files/2_Decemb er_2003%20cancer%20screening.pdf (Accessed: 16 April 2021).

[14] Arbyn M, Anttila A, Jordan J, Ronco G, Schenck U, Segnan N, et al. (eds.) European guidelines for quality assurance in cervical cancer screening. 2nd edn. European Commission, Office for Official Publications of the European Communities: Luxembourg. 2008.

[15] Anttila A, Arbyn A, De Vuyst H, Dillner J, Dillner L, Franceschi S, et al. (eds.) European guidelines for quality assurance in cervical cancer screening (pp. XIII–XXIV). 2nd edn, Supplements. Office for Official Publications of the European Union: Luxembourg. 2015.

[16] Italian Ministry of Health. Screening oncologici. Raccomandazioni per la pianificazione e l’esecuzione degli screening di popolazione per la prevenzione del cancro della mammella, del cancro della cervice uterina e del cancro del colon retto. 2006. Available at: http://www.salute.gov.it/imgs/C_17_pubblicazioni_774_alle gato.pdf (Accessed: 27 June 2021).

[17] Ronco G, Biggeri A, Confortini M, Naldoni C, Segnan N, Sideri M, et al. Health technology assessment report: HPV DNA based primary screening for cervical cancer precursors. Epidemiologia e Prevenzione. 2012; 36: e1–e72. (In Italian)

[18] Rossi PG, Ricciardi A, Cohet C, Palazzo F, Furnari G, Valle S, et al. Epidemiology and costs of cervical cancer screening and cervical dysplasia in Italy. BMC Public Health. 2009; 9: 71.

[19] RACCOMANDAZIONI SICPCV. 2019 Gestione colposcopica delle lesioni del basso tratto genitale. 2019. Available at: http://www.colposcopiaitaliana.it/pdf07/Capitolo_2_Gestio ne_delle_lesioni_citologiche.pdf (Accessed: 27 June 2021).

[20] SICPCV. Gestione della paziente con Pap test anormale Linee Guida Edizione 2006. La Colposcopia in Italia. 2006; 21: 1–25. (In Italian)

[21] Massad LS, Einstein MH, Huh WK, Katki HA, Kinney WK, Schiffman M, et al. 2012 ASCCP Consensus Guidelines Conference. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Journal of Lower Genital Tract Disease. 2013; 17: S1–S27.

[22] GISCi. Manuale del 2° livello. Raccomandazioni per la qualità nella diagnosi, terapia e follow up delle lesioni cervicali, nell’ambito dei programmi di screening. Gruppo di lavoro Gisci approfondimenti diagnostici e trattamento. 2010. Available at: https://www.gisci. it/documenti/documenti_gisci/Manuale_del_II_Livello.pdf (Accessed: 16 April 2021).

[23] Cuschieri K, Bhatia R, Cruickshank M, Hillemanns P, Arbyn M. HPV testing in the context of post-treatment follow up (test of cure). Journal of Clinical Virology. 2016; 76: S56–S61.

[24] Cubie HA, Canham M, Moore C, Pedraza J, Graham C, Cuschieri K. Evaluation of commercial HPV assays in the context of post-treatment follow-up: Scottish Test of Cure Study (STOCSH). Journal of Clinical Pathology. 2014; 67: 458–463.

[25] Gosvig CF, Huusom LD, Andersen KK, Duun-Henriksen AK, Frederiksen K, Iftner A, et al. Long-term follow-up of the risk for cervical intraepithelial neoplasia grade 2 or worse in HPV-negative women after conization. International Journal of Cancer. 2015; 137: 2927–2933.

[26] Morgan RL, Whaley P, Thayer KA, Schünemann HJ. Identifying the PECO: a framework for formulating good questions to explore the association of environmental and other exposures with health outcomes. Environment International. 2018; 121: 1027–1031.

[27] Kocken M, Uijterwaal MH, de Vries ALM, Berkhof J, Ket JCF, Helmerhorst TJM, et al. High-risk human papillomavirus testing versus cytology in predicting post-treatment disease in women treated for high-grade cervical disease: a systematic review and meta-analysis. Gynecologic Oncology. 2012; 125: 500–507.

[28] Whiting PF. QUADAS-2: a Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies. Annals of Internal Medicine. 2011; 155: 529–536.

[29] Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-i: a tool for assessing risk of bias in non-randomised studies of interventions. British Medical Journal. 2016; 355: i4919.

[30] Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. Journal of Clinical Epidemiology. 2011; 64: 401–406.

[31] Guyatt GH, Oxman AD, Schünemann HJ, Tugwell P, Knottnerus A. GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. Journal of Clinical Epidemiology. 2011; 64: 380–382.

[32] Ang C, Mukhopadhyay A, Burnley C, Faulkner K, Cross P, Martin-Hirsch P, et al. Histological recurrence and depth of loop treatment of the cervix in women of reproductive age: incomplete excision versus adverse pregnancy outcome. BJOG: an International Journal of Obstetrics and Gynaecology. 2011; 118: 685–692.

[33] Ghaem-Maghami S, De-Silva D, Tipples M, Lam S, Perryman K, Soutter W. Determinants of success in treating cervical intraepithelial neoplasia. BJOG: an International Journal of Obstetrics & Gynaecology. 2011; 118: 679–684.

[34] Ryu A, Nam K, Kwak J, Kim J, Jeon S. Early human papillomavirus testing predicts residual/recurrent disease after LEEP. Journal of Gynecologic Oncology. 2012; 23: 217–225.

[35] Serati M, Siesto G, Carollo S, Formenti G, Riva C, Cromi A, et al. Risk factors for cervical intraepithelial neoplasia recurrence after conization: a 10-year study. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2012; 165: 86–90.

[36] Torné A, Fusté P, Rodríguez-Carunchio L, Alonso I, del Pino M, Nonell R, et al. Intraoperative post-conisation human papillomavirus testing for early detection of treatment failure in patients with cervical intraepithelial neoplasia: a pilot study. BJOG: an International Journal of Obstetrics and Gynaecology. 2013; 120: 392–399.

[37] Simões RB, Campaner AB. Post-cervical conization outcomes in patients with high-grade intraepithelial lesions. Acta Pathologica, Microbiologica, Et Immunologica Scandinavica. 2013; 121: 1153–1161.

[38] Kong T, Son JH, Chang S, Paek J, Lee Y, Ryu H. Value of endo-cervical margin and high-risk human papillomavirus status after conization for high-grade cervical intraepithelial neoplasia, adenocarcinoma in situ, and microinvasive carcinoma of the uterine cervix. Gynecologic Oncology. 2014; 135: 468–473.

[39] Wongtiraporn W, Laiwejpithaya S, Sangkarat S, Benjapibal M, Rattanachaiyanont M, Ruengkhachorn I, et al. Long term outcomes of laser conization for high grade cervical intraepithelial neoplasia in Thai women. Asian Pacific Journal of Cancer Prevention. 2014; 15: 7757–7761.

[40] Andrade CEMC, Scapulatempo-Neto C, Longatto-Filho A, Vieira MA, Tsunoda AT, Da Silva IDCG, et al. Prognostic scores after surgical treatment for cervical intraepithelial neoplasia: a proposed model and possible implications for post-operative follow-up. Acta Obstetricia Et Gynecologica Scandinavica. 2014; 93: 941–948.

[41] Wu J, Jia Y, Luo M, Duan Z. Analysis of Residual/Recurrent Disease and its Risk Factors after Loop Electrosurgical Excision Procedure for High-Grade Cervical Intraepithelial Neoplasia. Gynecologic and Obstetric Investigation. 2016; 81: 296–301.

[42] Gosvig CF, Huusom LD, Deltour I, Andersen KK, Duun-Henriksen AK, Madsen EM, et al. Role of human papillomavirus testing and cytology in follow-up after conization. Acta Obstetri-cia Et Gynecologica Scandinavica. 2015; 94: 405–411.

[43] Ruano Y, Torrents M, Ferrer FJ. Human papillomavirus combined with cytology and margin status identifies patients at risk for recurrence after conization for high-grade cervical intraepithelial neoplasia. European Journal of Gynaecological Oncology. 2015; 36: 245–251.

[44] Banović M, Mahovlić V, Salopek KM, Banović V, Babić I, Orešković S, et al. The value of HPV-HR DNA testing during the follow-up after treatment of CIN3/AIS. Pathology Oncology Re-search. 2015; 21: 613–617.

[45] Mo L, Song H, Wang J, He Q, Qiu Z, Li F. Pap Smear Combined with HPV Testing: a Reasonable Tool for Women with High-grade Cervical Intraepithelial Neoplasia Treated by LEEP. Asian Pacific Journal of Cancer Prevention. 2015; 16: 4297–4302.

[46] Palmer JE, Ravenscroft S, Ellis K, Crossley J, Dudding N, Smith JH, et al. Does LLETZ excision margin status predict residual disease in women who have undergone post-treatment cervical cytology and high-risk human papillomavirus testing? Cytopathology. 2016; 27: 210–217.

[47] Ghaem-Maghami S, Sagi S, Majeed G, Soutter WP. Incomplete excision of cervical intraepithelial neoplasia and risk of treatment failure: a meta-analysis. The Lancet Oncology. 2007; 8: 985–993.

[48] Oliveira CAD, Russomano FB, Gomes Júnior SCDS, Corrêa FDM. Risk of persistent high-grade squamous intraepithelial lesion after electrosurgical excisional treatment with positive margins: a meta-analysis. Sao Paulo Medical Journal. 2012; 130: 119–125.

[49] Jin J, Li L, Zhang F. Meta-analysis of high risk factors of residue or relapse of cervical intraepithelial neoplasia after conization. Jour-nal of Biological Regulators & Homeostatic Agents. 2015; 29: 451–458.

[50] Onuki M, Matsumoto K, Sakurai M, Ochi H, Minaguchi T, Satoh T, et al. Posttreatment human papillomavirus testing for residual or recurrent high-grade cervical intraepithelial neoplasia: a pooled analysis. Journal of Gynecologic Oncology. 2016; 27: e3.

[51] Heymans J, Benoy IH, Poppe W, Depuydt CE. Type-specific HPV genotyping improves detection of recurrent high-grade cervical neoplasia after conisation. International Journal of Cancer. 2011; 129: 903–909.

[52] Cardoso FA, Campaner AB, Silva MALG. Prognostic value of p16(INK4a) as a marker of clinical evolution in patients with cervical intraepithelial neoplasia grade 3 (CIN 3) treated by cervical conization. Acta Pathologica, Microbiologica, Et Immunologica Scandinavica. 2014; 122: 192–199.

[53] Baser E, Ozgu E, Erkilinc S, Togrul C, Caglar M, Gungor T. Risk factors for human papillomavirus persistence among women undergoing cold-knife conization for treatment of high-grade cervical intraepithelial neoplasia. International Journal of Gynaecology and Obstetrics. 2014; 125: 275–278.

[54] Vintermyr OK, Iversen O, Thoresen S, Quint W, Molijn A, de Souza S, et al. Recurrent high-grade cervical lesion after primary conization is associated with persistent human papillomavirus in-fection in Norway. Gynecologic Oncology. 2014; 133: 159–166.

[55] Fu Y, Cheng X, Wang X, Cheng X, Wang X, Xie X, et al. Resid-ual disease and risk factors in patients with high-grade cervical intraepithelial neoplasia and positive margins after initial conization. Therapeutics and Clinical Risk Management. 2015; 11: 851–856.

[56] Wu D, Zheng Y, Chen W, Guo C, Yu J, Chen G, et al. Prediction of residual/recurrent disease by HPV genotype after loop excision procedure for high-grade cervical intraepithelial neoplasia with negative margins. The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2011; 51: 114–118.

[57] Katki HA, Schiffman M, Castle PE, Fetterman B, Poitras NE, Lorey T, et al. Five-year risk of recurrence after treatment of CIN 2, CIN 3, or AIS: performance of HPV and Pap cotesting in post-treatment management. Journal of Lower Genital Tract Disease. 2013; 17: S78–S84.

[58] Gosvig CF, Huusom LD, Andersen KK, Iftner A, Cederkvist L, Svare E, et al. Persistence and reappearance of high-risk human papillomavirus after conization. Gynecologic Oncology. 2013; 131: 661–666.

[59] Kreimer AR, Schiffman M, Herrero R, Hildesheim A, González P, Burk RD, et al. Long-term risk of recurrent cervical human papillomavirus infection and precancer and cancer following excisional treatment. International Journal of Cancer. 2012; 131: 211–218.

[60] Du R, Meng W, Chen ZF, Zhang Y, Chen SY, Ding Y. Post-treatment human papillomavirus status and recurrence rates in patients treated with loop electrosurgical excision procedure conization for cervical intraepithelial neoplasia. European Journal of Gynaecological Oncology. 2013; 34: 548–551.

[61] Söderlund-Strand A, Kjellberg L, Dillner J. Human papillomavirus type-specific persistence and recurrence after treatment for cervical dysplasia. Journal of Medical Virology. 2014; 86: 634–641.

[62] Jones J, Saleem A, Rai N, Shylasree TS, Ashman S, Gregory K, et al. Human Papillomavirus genotype testing combined with cytology as a ’test of cure’ post treatment: the importance of a persistent viral infection. Journal of Clinical Virology. 2011; 52: 88–92.

[63] Sarian LOZ, Derchain SFM, Pitta DDR, Morais SS, Rabelo-Santos SH. Factors associated with HPV persistence after treatment for high-grade cervical intraepithelial neoplasia with large loop exci-sion of the transformation zone (LLETZ) Journal of Clinical Virology. 2004; 31: 270–274.

[64] Alonso I, Torné A, Puig-Tintoré LM, Esteve R, Quinto L, Campo E, et al. Pre- and post-conization high-risk HPV testing predicts residual/recurrent disease in patients treated for CIN 2-3. Gynecologic Oncology. 2006; 103: 631–636.

[65] Kreimer AR, Guido RS, Solomon D, Schiffman M, Wacholder S, Jeronimo J, et al. Human papillomavirus testing following loop electrosurgical excision procedure identifies women at risk for posttreatment cervical intraepithelial neoplasia grade 2 or 3 disease. Cancer Epidemiology, Biomarkers & Prevention. 2006; 15: 908–914.

[66] Verguts J, Bronselaer B, Donders G, Arbyn M, Van Eldere J, Dri-jkoningen M, et al. Prediction of recurrence after treatment for high-grade cervical intraepithelial neoplasia: the role of human papillomavirus testing and age at conisation. BJOG: an International Journal of Obstetrics and Gynaecology. 2006; 113: 1303–1307.

[67] Smart OC, Sykes P, Macnab H, Jennings L. Testing for high risk human papilloma virus in the initial follow-up of women treated for high-grade squamous intraepithelial lesions. The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2010; 50: 164–167.

[68] Kocken M, Helmerhorst TJM, Berkhof J, Louwers JA, Nobbenhuis MAE, Bais AG, et al. Risk of recurrent high-grade cervical intraepithelial neoplasia after successful treatment: a long-term multicohort study. The Lancet Oncology. 2011; 12: 441–450.

[69] Dalla Palma P, Giorgi Rossi P, Collina G, Buccoliero AM, Ghiringhello B, Lestani M, et al. The risk of false-positive histology according to the reason for colposcopy referral in cervical cancer screening: a blind revision of all histologic lesions found in the NTCC trial. American Journal of Clinical Pathology. 2008; 129: 75–80.

[70] Molloy M, Comer R, Rogers P, Dowling M, Meskell P, Asbury K, et al. High risk HPV testing following treatment for cervical intraepithelial neoplasia. Irish Journal of Medical Science. 2016; 185: 895–900.

[71] Fallani MG, Penna C, Marchionni M, Bussani C, Pieralli A, Andersson KL, et al. Prognostic significance of high-risk HPV persistence after laser CO2 conization for high-grade CIN: a prospective clinical study. European Journal of Gynaecological Oncology. 2008; 29: 378–382.

[72] Kitchener HC, Walker PG, Nelson L, Hadwin R, Patnick J, An-thony GB, et al. HPV testing as an adjunct to cytology in the follow up of women treated for cervical intraepithelial neoplasia. BJOG: an International Journal of Obstetrics and Gynaecology. 2008; 115: 1001–1007.

[73] Leguevaque P, Motton S, Decharme A, Soulé-Tholy M, Escourrou G, Hoff J. Predictors of recurrence in high-grade cervical lesions and a plan of management. European Journal of Surgical Oncol-ogy. 2010; 36: 1073–1079.

[74] Lubrano A, Medina N, Benito V, Arencibia O, Falcón JM, Leon L, et al. Follow-up after LLETZ: a study of 682 cases of CIN 2-CIN 3 in a single institution. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2012; 161: 71–74.

[75] Ribaldone R, Boldorini R, Capuano A, Arrigoni S, Di Oto A, Surico N. Role of HPV testing in the follow-up of women treated for cervical dysplasia. Archives of Gynecology and Obstetrics. 2010; 282: 193–197.

[76] Nobbenhuis MA, Meijer CJ, van den Brule AJ, Rozendaal L, Voorhorst FJ, Risse EK, et al. Addition of high-risk HPV testing improves the current guidelines on follow-up after treatment for cervical intraepithelial neoplasia. British Journal of Cancer. 2001; 84: 796–801.

[77] Hogewoning CJA, Bleeker MCG, van den Brule AJC, Voorhorst FJ, Snijders PJF, Berkhof J, et al. Condom use promotes regression of cervical intraepithelial neoplasia and clearance of human papillomavirus: a randomized clinical trial. International Journal of Cancer. 2003; 107: 811–816.

[78] Bais AG, Eijkemans MJC, Rebolj M, Snijders PJF, Verheijen RHM, van Ballegooijen M, et al. Post-treatment CIN: randomised clinical trial using hrHPV testing for prediction of residual/recurrent disease. International Journal of Cancer. 2009; 124: 889–895.

[79] Strander B, Ryd W, Wallin K, Wärleby B, Zheng B, Milsom I, et al. Does HPV-status 6–12 months after treatment of high grade dysplasia in the uterine cervix predict long term recurrence? European Journal of Cancer. 2007; 43: 1849–1855.

[80] Moore EE, Danielewski JA, Garland SM, Tan J, Quinn MA, Stevens MP, et al. Clearance of human papillomavirus in women treated for cervical dysplasia. Obstetrics and Gynecology. 2011; 117: 101–108.

[81] Bottari F, Iacobone AD, Passerini R, Preti EP, Sandri MT, Cocuzza CE, et al. Human Papillomavirus Genotyping Compared with a Qualitative High-Risk Human Papillomavirus Test after Treatment of High-Grade Cervical Intraepithelial Neoplasia: A Systematic Review. Obstetrics & Gynecology. 2019; 134: 452–462.

[82] Hoffman SR, Le T, Lockhart A, Sanusi A, Dal Santo L, Davis M, et al. Patterns of persistent HPV infection after treatment for cervical intraepithelial neoplasia (CIN): a systematic review. International Journal of Cancer. 2017; 141: 8–23.

[83] GISCI. Prime 6 Raccomandazioni GISCI per il follow up post trat-tamento CIN2 e CIN3 riportate nel capitolo 5 del: Gruppo trasversale GISCi sul follow up dopo trattamento. Utilizzo del test HPV-HR nel triage delle ASC-US, delle LSIL in donne con più di 35 anni, nel follow-up delle donne con citologia ASC-US+ dopo un approfondimento di secondo livello negativo per CIN2+ e nel follow-up dopo trattamento delle lesioni CIN2-3: aggiornamento 2018. 2018. Available at: http://gisci.it/documenti/documenti_gisci/U tilizzo_test_HPV-HR_2018_def2.pdf (Accessed: 27 June 2021).

[84] LEGGE 8 marzo 2017, n. 24. Disposizioni in materia di sicurezza delle cure e della persona assistita, nonche’ in materia di re-sponsabilita’ professionale degli esercenti le professioni sanitarie.(17G00041) (Gazzetta Ufficiale Serie Generale n.64 del 17-03-2017. 2017, Available at: https://www.gazzettaufficiale.it/eli/id/ 2017/03/17/17G00041/sg (Accessed: 27 June 2021).

[85] SNLG-ISS. Methodological manual for the production of clinical practice guidelines. National Centre for Clinical Excellence, Quality and Safety of Care (CNEC), 2019. Available at: https://snlg.iss .it/wp-content/uploads/2019/04/MM_v1.3.2_apr_2019.pdf (Accessed: 27 June 2021).

[86] Schünemann HJ, Wiercioch W, Brozek J, Etxeandia-Ikobaltzeta I, Mustafa RA, Manja V, et al. GRADE Evidence to Decision (EtD) frameworks for adoption, adaptation, and de novo development of trustworthy recommendations: GRADE-ADOLOPMENT. Journal of Clinical Epidemiology. 2017; 81: 101–110.

[87] Istituto Superiore di Sanità. Sistema Nazionale Linee Guida dell’Istituto Superiore di Sanità. Available at: https://snlg.iss.it/(Accessed: 27 June 2021).



Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Submission Turnaround Time

Conferences

Top