Importance of human papillomavirus (HPV) screening in the follow-up after CIN2-3 treatment

• Published in: Journal de gynécologie, obstétrique et biologie de la reproduction Vol. 37; no. 4; pp. 329 - 337
• Main Authors: Riethmuller, D, Gabelle, C, Ramanah, R, Sautière, J-L, Prétet, J-L, Schaal, J-P, Kantelip, B, Mougin, C, Maillet, R
• Format: Journal Article
• Language: French
• Published: France Elsevier Masson 01.06.2008
• Subjects: Adult; Cancer; Cervical Intraepithelial Neoplasia; Cervical Intraepithelial Neoplasia - surgery; Cervical Intraepithelial Neoplasia - virology; Female; Follow-Up Studies; Humans; Life Sciences; Mass Screening; Neoplasm Recurrence, Local; Neoplasm Recurrence, Local - diagnosis; Neoplasm, Residual; Papillomaviridae; Papillomaviridae - isolation & purification; Papillomavirus Infections; Papillomavirus Infections - diagnosis; Predictive Value of Tests; Retrospective Studies; Sensitivity and Specificity; Uterine Cervical Neoplasms; Uterine Cervical Neoplasms - surgery; Uterine Cervical Neoplasms - virology
• DOI: 10.1016/j.jgyn.2007.12.012
• ISSN: 0368-2315

Cervical intraepithelial neoplasia (CIN) 2 and CIN3 lesions clearly represent precancerous states even if some of them would heal spontaneously. Management is based on surgical excision of part of the uterine cervix because such lesions can potentially progress into carcinomas. In most cases, this treatment leads to the cure of intraepithelial lesions. However, even after such an efficient treatment, theses patients are still at a higher risk of developing an invasive cervical cancer. That is why guidelines recommend a specific follow-up in order to screen for residual disease (incomplete excision) or for recurrences (after a complete excision). The actual problem in the follow-up strategy lies in the screening tools in use - cervical smears and colposcopy - whose sensitivities are low and hence, not quite sufficient when applied to a high risk population. These intraepithelial lesions are due to high risk human papillomaviruses (HPV) and there cannot be any lesion progression without HPV. Consequently, a viral testing would help in identifying a high risk subpopulation of women after cone loop cervical excision. We studied, retrospectively, the contribution of HPV testing (Hybrid Capture 2((R))) in the follow-up after CIN2-3 treatment in 386 cone loop cervical excisions performed at a single centre during 80 months. Between three to six months follow-up after surgery, HPV remained present in 22.5% cases. The sensitivity of HPV testing in the screening for residual lesions or for recurrences was 100%, that of cervical smears cytology was 72%, whereas that of the pathological analysis of margins reached only 67%. The negative predictive value of a negative HPV detection associated with a normal cytology was 100%. Owing to its clinical relevance, HPV testing optimises postoperative follow-up and leads to the rapid and efficient selection of a subgroup, representing less than one upon three patients who are really at risk of an invasive lesion and to wholly reassure the others. Indeed, a negative HPV testing, associated with a normal cervical cytology, obtained after surgery correspond to a negative predictive value of almost 100% and this allows us to increase the time-interval between two screenings and to rapidly place the patient in a routine follow-up.