Predictors of Absence of Cervical Intraepithelial Neoplasia in the Conization Specimen
Leonardo Rodriguez-Carunchio, Agata Rodriguez-Manfredi, Immaculada Alonso, Marta del Pino, Pere Fuste, Aureli Torne, Jaume Ordi. CRESIB (Centre de Recerca en Salut Internacional de Barcelona) Hospital Clínic, University of Barcelona Faculty of Medicine, Barcelona, Spain; Hospital Clínic-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain
Background: Conization is the standard treatment in patients with high-grade squamous intraepithelial lesions (H-SIL, CIN2-3) and also in a subset of patients with low-grade squamous intraepithelial lesions (LSIL, CIN1). Several studies have shown that in over 10% of women who undergo conization for CIN, no lesion is observed in the surgical specimen. We aimed to determine whether these patients could be identified before conization using clinical, virological and/or cyto-histological characteristics, to avoid unnecessary treatment.
Design: Of 687 women with CIN treated by conization in the Hospital Clinic of Barcelona between 2008 and 2011, all patients (n=110, 16%) showing no lesion in the surgical specimen were included as the study group. Patients with glandular abnormalities or previous conization were excluded. The control group included a series of randomly selected women with CIN confirmed in the cone specimen (n=220). Pre-conization clinical, cytological and histological characteristics as well as high-risk human papillomavirus (hr-HPV) status determined by Hybrid Capture 2 were analyzed as possible predictors of absence of lesion.
Results: A negative pre-conization hr-HPV test or a low viral load (< 10 relative light units[RLU]) significantly increased the probability of absence of CIN in the conization specimen (75.0%, and 52% respectively) compared with patients with a viral load higher than 10 RLU, (28.9%, p<0.001). This association was confirmed in the multivariate analysis (p<0.001). No significant differences were observed in terms of percentage of persistent/recurrent disease after conization between patients from the study and control groups.In contrast, the risk of developing persistent/recurrent disease after treatment was significantly lower in patients with negative result or a low viral load (16.1% CIN1, 0% CIN2-3), than in patients with a high viral load (27.6% CIN1, 4.1% CIN2-3, p=0.031).
Conclusions: Women with negative pre-conization hr-HPV test results or a low viral load have a high probability of having no lesion in the conization specimen. These patients should be excluded from immediate surgical excision and considered for follow-up.
Category: Gynecologic & Obstetrics
Tuesday, March 5, 2013 1:00 PM
Poster Session IV # 220, Tuesday Afternoon