Abstract
Colposcopy is often used in follow-up after treatment for cervical intraepithelial neoplasia (CIN) despite its marked inter-observer variability and low sensitivity. Our objective was to assess the role of colposcopy in post-treatment follow-up in comparison to hrHPV (high-risk human papillomavirus) testing, cytology, and cone margin status. Altogether, 419 women treated for histological high-grade lesion (HSIL) with large loop excision of the transformation zone (LLETZ) attended colposcopy with cytology and hrHPV test at six months. Follow-up for recurrence of HSIL continued for 24 months. Colposcopy was considered positive if colposcopic impression was recorded as high grade and cytology if HSIL, ASC-H (atypical squamous cells, cannot exclude HSIL), or AGC-FN (atypical glandular cells, favor neoplasia) were present. Overall, 10 (10/419, 2.4%) recurrent HSIL cases were detected, 5 at 6 months and 5 at 12 months. Colposcopic impression was recorded at 407/419 6-month visits and was positive for 11/407 (2.7%). None of them had recurrent lesions, resulting in 0% sensitivity and 97% specificity for colposcopy. Sensitivity for the hrHPV test at 6 months was 100% and specificity 85%, for cytology 40% and 99%, and for margin status at treatment 60% and 82%, respectively. While the hrHPV test is highly sensitive in predicting recurrence after local treatment for CIN, colposcopy in an unselected population is not useful in follow-up after treatment of CIN.
Highlights
Cervical cancer develops from precursor lesions called cervical intraepithelial neoplasia (CIN), which can be treated before their progression into cancer [1]
Treatment of CIN is effective in preventing subsequent invasive cervical cancer, but women treated for CIN remain at increased risk of developing new CIN compared to the general population [6]
We aimed to explore the value of colposcopy in women with positive margins
Summary
Cervical cancer develops from precursor lesions called cervical intraepithelial neoplasia (CIN), which can be treated before their progression into cancer [1]. Treatment of CIN is effective in preventing subsequent invasive cervical cancer, but women treated for CIN remain at increased risk of developing new CIN compared to the general population [6]. The majority of cases develop within the first two years after treatment [7,8] and approximately 7% of treated women are diagnosed with recurrence during the 18-month follow-up period [9]. Large lesion size and increasing histopathological grade of the lesion, smoking, older age of the patient, involved cone margins, and hrHPV (high-risk human papillomavirus) persistence have been detected as risk factors that predict recurrence [10,11,12]. Compared to the general population, the risk for cervical cancer after treatment for CIN is increased for at least 25 years [11,13,14,15]
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