HPV Testing and Cytologic/Histopathologic Follow-Up Results after Excisional Treatment for High Grade Cervical Intraepithelial Neoplasia
Wei Hong, Zaibo Li, Baoying Weng, Millon Amin, Marshall Austin, Chengquan Zhao. Conemaugh Memorial Medical Center, Johnstown, PA; Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA
Background: Excision of the transformation zone under colposcopic guidance is standard treatment for CIN2/3. This large study assessed factors impacting risk of residual or recurrent disease after excisional treatment for CIN2/3.
Design: A search of the CoPath file was carried out to retrieve cases with histopathologic diagnoses of CIN2/3 during a period of 54 months. Surgical pathology reports, follow-up hrHPV testing, cytologic, and histopathologic results were recorded.
Results: 1453 patients with histopathologic CIN2/3 diagnosis treated by conization were identified and 432 patients without follow-up were excluded. 988 patients with cytologic and/or histopathologic follow-up results were included with an average age of 31.8 years (range: 16 - 80; median: 28) and average follow-up period of 35.5 months (range: 1-87, median: 34). CIN2/3/HSIL detection rate was 6.8% (67/988). The interval between conization and initial follow-up CIN 2/3/HSIL diagnoses was approximately 20 months (range: 1- 57, median: 13). Residual/recurrent disease was associated with significantly higher CIN grade, positive margins after conization, or hrHPV positive results, and was not related to age (<30 yr vs >=30 yr) (Table 1). 514 women had hrHPV testing during the follow-up period and 32.3% had positive hrHPV results. CIN2/3 was detected in only 1.4% (5/348) of patients with follow-up hrHPV-negative results, compared to 15.1% (25/166) of patients with HPV-positive results. 45 of 67 (67.2%) cases with recurrence of CIN2/3 were present within 2 years after the conization.
Conclusions: In a large study of 1453 patients with CIN2/3 treated by conization, follow-up hrHPV testing was confirmed as very helpful in identifying patients with residual/recurrent CIN2/3, especially in patients with negative conization margins. Cytology and HPV cotesting is preferred for follow-up of women after CIN2/3 excisions.
|Histopathology||219||64 (29.2%)||109 (49.8%)|
|Cytology only||769||3 (0.4%)||56 (7.3%)|
|Margin positive||231||34 (14.7%)||49 (21.2%)|
|Margin negative||757||33 (4.4%)||116 (15.3%)|
|Original dx:CIN2||677||36 (5.3%)||118 (17.4%)|
|Original dx:CIN3||311||31 (10.0%)||47 (15.1%)|
|<30 y||531||32 (6.0%)||89 (16.8%)|
|>=30 y||457||35 (7.7%)||76 (16.6%)|
|HPV positive*||166||25 (15.1%)||66 (39.8%)|
|HPV negative only||348||5 (1.4%)||40 (11.5%)|