Short summary

Cytology can possible be omitted in the follow-up after conization for cervical intraepithelial neoplasia - the aim of this study is to investigate whether HPV-testing can stand alone as a clinical prognostic tool for identifying women at risk for recurrent disease three years after treatment for precuror lesions.

Rationale

Follow-up after conization for cervical intraepithelial neoplasia is important, as there is as a markedly increased risk for residual and recurrent dysplasia. Through the years, several strategies for follow-up after treatment for precursor lesion have been proposed. Some of those frequently used are cytological examination of a cell sample from cervix uteri combined with colposcopy, information about the resection margin and test for human papillomavirus (HPV). In recent years there has been a great focus on the significance of HPV-testing and the combination of HPV-testing and cytology after cone biopsy. It seems that HPV-testing could be a useful strategy for managing follow-up after treatment for precursor lesion, but so far there is no international consensus regarding the number of tests or follow-up visits necessary in the post-treatment surveillance.

A small study conducted at Southern Jutland Hospital, included 128 women with histologically verified CIN2+ who had a conization performed between 1 January 2013 and 31 December 2013. Histology, cytology and HPV-test results were obtained for a three year follow-up period.

Using only margin status and HPV-test in surveillance post-treatment for CIN2+ gave an equally high sensitivity and negative predictive value as the current used method recommended by the Danish National Board of Health, combining cytology, HPV-test and resection margin status. Cytology could be omitted from post-treatment management without lowering negative predictive value, indicating that follow-up management guidelines possible could be modified.  

However, to find the best strategy for follow-up of CIN2+-treated patients larger studies are needed to verify the findings.

The next step is to investigate if the results can be reproduced in a larger cohort. 

The study is conducted retrospectively and includes women who had a conization performed at any hospital in Denmark between 1 January 2013 and 31 December 2013. 

Description of the cohort

The cohort includes women who had a conization performed at any hospital in Denmark between 1 January 2013 and 31 December 2013. The women are identified using the SNOMED code for cone T83701 in The National Patholgy Data Bank (Patobank). 

Data and biological material

Histology, cytology and HPV test results for a three year follow-up period are obtained in The National Patholgy Data Bank (Patobank). 

Collaborating researchers and departments

Department of Pathology, Southern Jutland Hospital

• Jalil Hariri, MD

Publications associated with the project

HPV-testing versus HPV-cytology co-testing to predict the outcome after conization. Bruhn LV, Andersen SJ, Hariri J.Acta Obstet Gynecol Scand 2018; https://doi.org/10.1111/aogs.13325