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.\n
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.
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