Role of human papillomavirus testing and cytology in follow-up after conization

TY - JOUR

T1 - Role of human papillomavirus testing and cytology in follow-up after conization

AU - Gosvig, Camilla F

AU - Huusom, Lene D

AU - Deltour, Isabelle

AU - Andersen, Klaus Kaae

AU - Duun-Henriksen, Anne Katrine

AU - Madsen, Ellen Merete

AU - Petersen, Lone Kjeld

AU - Elving, Lisbeth B

AU - Schouenbourg, Lars

AU - Iftner, Angelika

AU - Svare, Edith

AU - Iftner, Thomas

AU - Kjaer, Susanne K

N1 - © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

PY - 2015/4/1

Y1 - 2015/4/1

N2 - OBJECTIVE: Adequate follow-up of women who have undergone conization for high-grade cervical lesions is crucial in cervical cancer screening programs. We evaluated the performance of testing for high-risk human papillomavirus (HPV) types, cytology alone, and combined testing in predicting cervical intraepithelial neoplasia grade 2 or worse (CIN2+) after conization.DESIGN: Prospective cohort study.SETTING: Denmark.POPULATION: 667 women attending for conization.METHODS: Cervical specimens were collected during 2002-2006 at first visit after conization for cytological examination and Hybrid Capture 2 detection of high-risk HPV. The women were passively followed until 2 years after first follow-up visit by linkage to the nationwide Pathology Data Bank.RESULTS: At first visit after conization (median time, 3.4 months), 20.4% were HPV-positive and 17.2% had atypical squamous intraepithelial lesions or more severe cytology (ASCUS+). The 2-year incidence of CIN2+ after conization was 3.6%. Sensitivity for detection of CIN2+ after conization was 81.0% [95% confidence interval (CI) 58.1-94.6] for positive cytology (ASCUS+ threshold) and 95.2% (95% CI 76.2-99.9) for HPV testing and for combined testing. Specificity of ASCUS+ cytology (85.2%; 95% CI 82.0-88.0) was higher than that of HPV testing (82.4%; 95% CI 79.0-85.4) and markedly higher than that of combined testing (73.2%; 95% CI 69.3-76.8). The margin status had no significant added value.CONCLUSIONS: Testing for high-risk HPV three to four months after conization is more sensitive than ASCUS+ cytology for identifying women at risk for relapse of CIN2+ within 2 years. Further studies are needed to evaluate whether HPV testing could be a stand-alone test in follow up after conization.

AB - OBJECTIVE: Adequate follow-up of women who have undergone conization for high-grade cervical lesions is crucial in cervical cancer screening programs. We evaluated the performance of testing for high-risk human papillomavirus (HPV) types, cytology alone, and combined testing in predicting cervical intraepithelial neoplasia grade 2 or worse (CIN2+) after conization.DESIGN: Prospective cohort study.SETTING: Denmark.POPULATION: 667 women attending for conization.METHODS: Cervical specimens were collected during 2002-2006 at first visit after conization for cytological examination and Hybrid Capture 2 detection of high-risk HPV. The women were passively followed until 2 years after first follow-up visit by linkage to the nationwide Pathology Data Bank.RESULTS: At first visit after conization (median time, 3.4 months), 20.4% were HPV-positive and 17.2% had atypical squamous intraepithelial lesions or more severe cytology (ASCUS+). The 2-year incidence of CIN2+ after conization was 3.6%. Sensitivity for detection of CIN2+ after conization was 81.0% [95% confidence interval (CI) 58.1-94.6] for positive cytology (ASCUS+ threshold) and 95.2% (95% CI 76.2-99.9) for HPV testing and for combined testing. Specificity of ASCUS+ cytology (85.2%; 95% CI 82.0-88.0) was higher than that of HPV testing (82.4%; 95% CI 79.0-85.4) and markedly higher than that of combined testing (73.2%; 95% CI 69.3-76.8). The margin status had no significant added value.CONCLUSIONS: Testing for high-risk HPV three to four months after conization is more sensitive than ASCUS+ cytology for identifying women at risk for relapse of CIN2+ within 2 years. Further studies are needed to evaluate whether HPV testing could be a stand-alone test in follow up after conization.

KW - Adult

KW - Cervical Intraepithelial Neoplasia

KW - Conization

KW - Early Detection of Cancer

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Neoplasm Recurrence, Local

KW - Papillomavirus Infections

KW - Prospective Studies

KW - Sensitivity and Specificity

KW - Uterine Cervical Neoplasms

KW - Vaginal Smears

U2 - 10.1111/aogs.12601

DO - 10.1111/aogs.12601

M3 - Journal article

C2 - 25645089

SN - 0001-6349

VL - 94

SP - 405

EP - 411

JO - Acta Obstetrica et Gynecologica

JF - Acta Obstetrica et Gynecologica

IS - 4

ER -