226 Clearance of HPV after conization of cervical cancer and adenocarcinoma in situ correlates with absence of cancer

Abstract

<h3>Introduction/Background*</h3> About 40% of CC are in women under age 40 years, for whom fertility-sparing treatment might be very important and should always be considered. More than half the patients who undergo radical surgery (trachelectomy or hysterectomy) have no remnant tumor in the final pathology specimen. HPV clearance is a test of cure after conisation, but it is not a test of cure in CC. Our objective was to assess correlation of clearance of high-risk human papillomavirus (HR-HPV) after large loop excision of the transformation zone (LLETZ) with absence of residual disease, in women diagnosed with cervical cancer (CC) and Adenocarcinoma in Situ (AIS). <h3>Methodology</h3> Data was collected from 92 women diagnosed with CC and AIS who were positive to High –Risk HPV (HR-HPV), and had a repeat cervical HPV test 3-12 weeks post-LLETZ, and before final surgical treatment. We compared characteristics of women with negative and positive HR-HPV post-LLETZ. <h3>Result(s)*</h3> The pathological results of women who were HR-HPV negative (n=40) compared to HR-HPV positive (n=52) at the post-LLETZ follow-up visit included a significantly higher incidence of AIS: 14 (35%) vs 5(9.6%) (p&lt; 0.006). In the negative HR-HPV post-LLETZ group, 36 (90%) had normal histology and only 2 (5%) had cancer in the final histological specimen. Among women who underwent radical hysterectomy/trachelectomy after LLETZ, a normal final histology was observed in 75% and 9% of those who were HR-HPV negative and HR-HPV positive, respectively (p&lt;0.0005). The negative predictive value for residual cancer, with clearance of HR-HPV after LLETZ was 95%. <h3>Conclusion*</h3> Clearance of HR-HPV from the cervix a short time after LLETZ has a high correlation with the absence of residual cancer in the final outcome, either in the pathology or the follow up. Testing for HR-HPV a short time after LLETZ might serve as a parameter for risk assessment.