Human Papilloma Virus Test Combined With Thinprep Cytologic Test in Evaluation of Therapeutic Effects of Loop Electrosurgical Excision Procedure and the Follow-Up for High-Grade Cervical Intraepithelial Neoplasia

Abstract

Objective To explore the therapeutic effects of human papilloma virus (HPV) test combined with thinprep cytologic test (TCT) on evaluating loop electrosurgical excision procedure (LEEP) and the follow-up of high-grade cervical intraepithelial neoplasia(CIN). Methods From March 2005 to December 2006, 115 patients who subjected to loop electrosurgical excision procedure(LEEP) due to histologically confirmed cervical intraepithelial neoplasia(CIN) Ⅱ/Ⅲ were selected. They were classified into two groups according to the diagnosis, one of which was consisted of patients with cervical intraepithelial neoplasia Ⅱ(CINⅡ group, n=68, 59.13%), the other with cervical intraepithelial neoplasiaⅢ(including carcinoma in situ, CIN Ⅲ group, n=47, 40.87%). The study was according to the ethical standards enacted by the ethics committee and confirmed by the committee. Informed consent was obtained from all participates. All 115 cases who underwent loop excision procedure were followed-up until January 2008. Follow–up visits were consisted of cervical thinprep cytologic test during the following 4~6 months after the operation and hybrid capture Ⅱ (HC2) during the following 6~8 months. A retrospective analysis was performed to study effects and prognosis after loop electrosurgical excision procedure. Results The positive human papilloma virus rate was 95.74% in CIN Ⅲ group which was significantly higher than that in CIN Ⅱ group (73.53%) before loop electrosurgical excision(P 0.05). The sensitivity, specificity, positive predictive value(PPV), negative predictive value of hybrid capture Ⅱ were 66.67%, 98.12%, 57.14%, 98.15%. While the sensitivity, specificity, positive predictive value, negative predictive value of the thinprep cytologic test were 83.33%, 76.15%, 16.13%, 98.81%. Four cases whose hybrid capture Ⅱ and thinprep cytologic test both were positive showed residual or recurrent. Specificity and positive predictive value were significantly higher when two tests were combined. Conclusion Loop electrosurgical excision procedure is an effective way for treating high–grade cervical intraepithelial neoplasia. High risk human papilloma virus may play an important role in the occurrence of high grade cervical intraepithelial neoplasia. Pre–treatment of high risk human papilloma virus testing seems to have no predictive value for the prognosis of patients who undergo loop electrosurgical excision procedure for high–grade cervical intraepithelial neoplasia. High risk human papilloma virus combined with thinprep cytologic test during the post–treatment may be of great importance after loop electrosurgical excision procedure. Key words: cervical intraepithelial neoplasia (CIN); loop electrosurgical excision procedure (LEEP); human papilloma virus (HPV); thinprep cytologic test (TCT)