Human papilloma virus testing in patient follow-up post cone biopsy due to high-grade cervical intraepithelial neoplasia

Abstract

Objectives We evaluated the contribution of the human papilloma virus (HPV) load in planning follow-up and management of women post cone biopsy for high-grade cervical intraepithelial neoplasia (CIN2–3). Methods Ninety-six suitable women were followed-up by Pap smears: two consecutive abnormal smears dictated referral for colposcopy-directed biopsy. Before colposcopy, HPV tests determined high-risk HPV DNA type and load (Hybrid Capture System type I). Patients histologically diagnosed with CIN1 or CIN2–3 underwent repeat conization or hysterectomy for residual disease. HPV load was compared to cytology for the detection of residual disease. Results At follow-up, 20/89 (22.4%) studied women had positive cytology reports of either low- ( n = 11) or high-grade ( n = 9) squamous intraepithelial lesion (SIL). Colposcopic biopsies diagnosed 9 CIN1 and 8 CIN2–3 cases. Residual disease was corroborated in 16/17 (94.1%) women and the status was readjusted based on cone biopsy/hysterectomy: CIN2–3 in 9 and CIN1 in 7. The positive prediction values for CIN2–3 residual disease with high-grade SIL, CIN2–3 on colposcopic punch biopsy, and high HPV load were 89, 100, and 100%, respectively. For CIN1 residual disease with low-grade SIL, CIN1 on colposcopic punch biopsy, and low and borderline HPV load, they were 54.5, 77.7, and 100%. The HPV load was a more accurate predictor for CIN1 or CIN2–3 on the cervical specimen in cases with low-grade SIL or CIN1 on colposcopic biopsy. Conclusions Evaluating HPV loads after a positive cytology report may assist in triaging women post conization biopsy for CIN2–3 to appropriate treatment. Its high positive predictive value, specificity, and sensitivity for CIN1 and CIN2–3 and supplementary information could be especially pertinent for clinical management of low-grade SIL cases.