[1162] 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.

Risk factors associated with recurrent CIN lesions in women with CIN2/3 after the conization
 Total PatientsCIN2/3/HSILCIN1/LSIL
Histopathology21964 (29.2%)109 (49.8%)
Cytology only7693 (0.4%)56 (7.3%)
Margin positive23134 (14.7%)49 (21.2%)
Margin negative75733 (4.4%)116 (15.3%)
Original dx:CIN267736 (5.3%)118 (17.4%)
Original dx:CIN331131 (10.0%)47 (15.1%)
<30 y53132 (6.0%)89 (16.8%)
>=30 y45735 (7.7%)76 (16.6%)
HPV positive*16625 (15.1%)66 (39.8%)
HPV negative only3485 (1.4%)40 (11.5%)
*at least one positive HPV test.


Category: Gynecologic & Obstetrics

Tuesday, March 5, 2013 1:00 PM

Poster Session IV # 221, Tuesday Afternoon

 

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