Performance of Pap smear and human papilloma virus testing in the follow-up of women with cervical intraepithelial neoplasia grade 1 managed conservatively

• Published in: Acta obstetricia et gynecologica Scandinavica Vol. 85; no. 4; pp. 444 - 450
• Main Authors: Luis Ferreira Santos, André, Françoise Mauricette Derchain, Sophie, Otávio Sarian, Luis, Roberto Martins, Marcos, Siani Morais, Sirlei, Juhani Syrjänen, Kari
• Format: Journal Article
• Language: English
• Published: Oxford, UK Informa UK Ltd 01.04.2006; Blackwell Publishing Ltd; Taylor & Francis
• Subjects: Adolescent; Adult; Biological and medical sciences; Cervical Intraepithelial Neoplasia - diagnosis; Cervical Intraepithelial Neoplasia - therapy; Cervical Intraepithelial Neoplasia - virology; Cohort Studies; Disease Progression; Female; Female genital diseases; follow-up; Gynecology. Andrology. Obstetrics; HPV; Humans; low-grade cervical intraepithelial neoplasia; Medical sciences; Middle Aged; Odds Ratio; Papanicolaou Test; Papillomavirus Infections - diagnosis; Pregnancy; progression; regression; Risk Factors; Tumors; Vaginal Smears; Performance evaluation; Cervical smear; progression; Papovaviridae; Follow-up; HPV; Papillomavirus; Human papillomavirus; Cervical dysplasia; Cervical intraepithelial neoplasia; Adult; Female; Woman; low-grade cervical intraepithelial neoplasia; Low grade; Human; Premalignant lesion; Gynecology; Regression; Medical screening; Obstetrics; Female genital diseases; Virus; Surveillance; Uterine cervix diseases
• ISSN: 0001-6349; 1600-0412
• DOI: 10.1080/00016340600604682

Background. Conservative management (follow-up) of cervical intraepithelial neoplasia grade 1 (CIN1) is acceptable, but evidence on performance of follow-up tools, such as Pap smear and human papilloma virus (HPV) test, is still needed. Methods. A cohort of 78 women with histologically confirmed CIN1, referred because of atypical squamous cell or low-grade squamous intraepithelial lesion in their Pap smear, was enrolled between August 2000 and September 2002 and was prospectively followed-up at 6 and 12 months, until September 2003. Follow-up examinations included Pap test and Hybrid Capture II (HCII) with high-risk HPV, colposcopy, and cervical biopsies in patients with persistent abnormalities. Odds ratios and performance indicators (with 95% confidence interval) were calculated for HPV and Pap test results in detecting biopsy-confirmed CIN during the follow-up. Results. Thirty-seven (47%) of the women were HPV-positive at baseline. At first follow-up visit, 30 women had persistent CIN1 and one woman progressed to CIN2; 15 patients had CIN1 and one patient CIN2 at the second follow-up visit. Women with persistent CIN1 (or progression) during follow-up had a significantly higher HPV detection rate and abnormal Pap tests, compared to women with regressive disease. Cytology had a far better sensitivity in detecting CIN than HCII at the first follow-up visit (81 versus 52%, respectively), whereas both examinations had equivalent sensitivities at the second follow-up visit (69 and 56%, respectively). Cytology had a superior negative predictive value at the first follow-up visit and better positive predictive value, in addition, at the second visit. Conclusions. Because cytological abnormalities correlated generally better with the persistence of biopsy-confirmed CIN1 in this follow-up protocol, HCII test is the second-hand option to Pap test, but the use of both Pap and HCII together seems an unnecessary waste of resources.