The Clinical Usefulness of Human Papillomavirus Testing in the Follow-up of Women after Treatment for Cervical Intraepithelial Neoplasia

Abstract

To compare the effectiveness of human papillomavirus (HPV) testing and cervical cytologic analysis in monitoring patients after treatment for cervical intraepithelial neoplasia. A retrospective study comparing cytologic analysis and HPV testing using the follow-up protocol recommended by the American Society for Colposcopy and Cervical Pathology Consensus Conference. Sixty-one patients were seen for a total of 193 follow-up patient visits. In 120 visits, both cytologic and HPV results were available. Specificity, sensitivity, positive and negative predictive values, and the rate of referral to colposcopy were calculated. In 68 visits, both HPV and cytologic results were negative, and in 19, both were positive. In 21 visits, cytologic results were positive and HPV results were negative, and in 12 visits, cytologic results were negative and HPV results were positive. The specificity of cytologic analysis and HPV testing was 68.3% and 75.8%, respectively (p = .16). The positive predictive value for cytologic analysis and HPV testing was 6.5% and 7.5%, respectively, and the negative predictive value was 100% and 98.9%, respectively. Had either test been used alone, cytologic analysis would have referred 40 patients to colposcopy and HPV testing would have referred 31 patients. Had both been used in combination, 52 patients would have required colposcopy with no significant improvement in the amount of disease detected. Both cytologic analysis and HPV testing are equally effective in monitoring patients after treatment for cervical intraepithelial neoplasia. The simultaneous use of cytologic analysis and HPV testing significantly increased colposcopy referrals without increasing the amount of disease detected.