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Human Papillomavirus Testing and the Outcome of Treatment for Cervical Intraepithelial Neoplasia

From the Department of Gynecology, Biostatistics and Cytopathology Laboratories, Ioannina University Hospital, Ioannina, Greece; and the Academic Unit of Obstetrics and Gynecology, St Mary’s Hospital, Manchester, United Kingdom.

Address reprint requests to: Evangelos Paraskevaidis, MD, Visiting Professor, Academic Unit of Obstetrics and Gynaecology, St. Mary’s Hospital, Whitworth Park, Manchester M13 0JH, United Kingdom; E-mail: vangelispar{at}hotmail.com.

OBJECTIVE: To investigate whether human papillomavirus (HPV) testing could be used in the follow-up after large loop excision of the transformation zone (LLETZ) for cervical intraepithelial neoplasia (CIN).

METHODS: We performed a retrospective study of 41 women who developed subsequent CIN after LLETZ (group A) and 82 women without CIN for a minimum of 5 years after LLETZ (group B). The first post-treatment cervical smear was retrieved and examined for high-risk HPV deoxyribonucleic acid. The sensitivity, specificity, positive and negative likelihood ratio of HPV testing, first post-treatment Papanicolaou test, and excision margins for the detection of treatment failure were calculated. Multiple logistic regression analysis was also done.

RESULTS: The HPV test was positive in 38 of 41 women in group A and 13 of 82 in group B (P < .001). An abnormal cytologic result in the first post-treatment smear was found in 20 of 41 in group A and 11 of 82 in group B (P < .001). Sixteen women in group A and 18 in group B had involved margins (P = .046). Values for the sensitivity, specificity, and positive and negative likelihood ratios of the HPV test were 93%, 84%, 5.8, 0.08; for the Papanicolaou test they were 49%, 87%, 3.9, 0.586; and for margin status they were 39%, 78%, 1.8, 0.782, respectively. Positive HPV test presents significantly high odds ratio for treatment failure (P < .001), independent of cytology and margin status.

CONCLUSION: Women who postoperatively have positive HPV testing are at higher risk of treatment failure. This could be performed at the first post-treatment visit and further follow-up could be adjusted accordingly.

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