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Application of HPV DNA Testing in Follow-up after Loop Electrosurgical Excision Procedures in Northern Thailand

  • Published : 2015.09.02

Abstract

Background: HPV DNA testing has been recently introduced as an adjunct test to cytology in the follow-up of patients after treatment for cervical lesions using the loop electrosurgical excision procedure (LEEP). The aim of this study was to evaluate the role of HPV testing in the detection of persistent or recurrent disease after LEEP in patients with cervical epithelial lesions in northern Thailand. Materials and Methods: Patients who underwent LEEP as a treatment for histological low-grade (LSIL) or high-grade squamous intraepithelial lesion (HSIL) or worse at Chiang Mai University Hospital between June 2010 and May 2012 were included. Follow-ups were scheduled at 6-month intervals and continued for 2 years using co-testing (liquid-based cytology and Hybrid Capture 2 [HC2]) at 6 months and 24 months and liquid-based cytology alone at 12 and 18 months. Results: Of 98 patients included, the histological diagnoses for LEEP included LSIL in 16 patients, and HSIL or worse in 82 patients. The LEEP margin status was negative in 84 patients (85.7%). At follow-up, 10 patients (10.2%) had persistent/recurrent lesions; 4 among LSIL patients (25.0%) and 6 in the group with HSIL or worse (7.3%). Only 2 of 82 patients (2.4%) with HSIL or worse diagnoses had histological HSIL in the persistent/recurrent lesions. Using histologically confirmed LSIL as the threshold for the detection of persistent/recurrent disease, cytology had a higher sensitivity than HC2 (90.0% versus 70.0%). At the 6-month follow-up appointment, combined cytology and HC2 (co-testing) had a higher sensitivity in predicting persistent/recurrent disease (80.0%) compared with that of cytology alone (70.0%) and HC2 (50.0%). Conclusions: After LEEP with a negative surgical margin, the rate of persistent/recurrent lesions is low. The addition of HPV testing at the 6-month visit to the usual cytology schedule may be an effective approach in the follow-up after LEEP.

References

  1. Alonso I, Torne A, Puig-Tintore LM, et al (2006). Pre- and post-conization high-risk HPV testing predicts residual/ recurrent disease in patients treated for CIN 2-3. Gynecol Oncol, 103, 631-6. https://doi.org/10.1016/j.ygyno.2006.04.016
  2. Alonso I, Torne A, Puig-Tintore LM, et al (2007). High-risk cervical epithelial neoplasia grade 1 treated by loop electrosurgical excision: follow-up and value of HPV testing. Am J Obstet Gynecol, 197, 359.
  3. Houfflin Debarge V, Collinet P, Vinatier D, et al (2003). Value of human papillomavirus testing after conization by loop electrosurgical excision for high-grade squamous intraepithelial lesions. Gynecol Oncol, 90, 587-92. https://doi.org/10.1016/S0090-8258(03)00372-X
  4. Jeong NH, Lee NW, Kim HJ, et al (2009). High-risk human papillomavirus testing for monitoring patients treated for high-grade cervical intraepithelial neoplasia. J Obstet Gynaecol Res, 35, 706-11. https://doi.org/10.1111/j.1447-0756.2008.00989.x
  5. Kitchener HC, Walker PG, Nelson L, et al (2008). HPV testing as an adjunct to cytology in the follow up of women treated for cervical intraepithelial neoplasia. BJOG, 115, 1001-7. https://doi.org/10.1111/j.1471-0528.2008.01748.x
  6. Lubrano A, Medina N, Benito V, et al (2012). Follow-up after LLETZ: a study of 682 cases of CIN 2-CIN 3 in a single institution. Eur J Obstet Gynecol Reprod Biol, 161, 71-4. https://doi.org/10.1016/j.ejogrb.2011.11.023
  7. Nam K, Chung S, Kim J, et al (2009). Factors associated with HPV persistence after conization in patients with negative margins. J Gynecol Oncol, 20, 91-5. https://doi.org/10.3802/jgo.2009.20.2.91
  8. Nessa A, Rashid MH, Jahan M, et al (2014). Role of the HPV DNA test in follow-up of treated cervical intraepithelial neoplasia in Bangladesh. Asian Pac J Cancer Prev, 15, 8063-7. https://doi.org/10.7314/APJCP.2014.15.19.8063
  9. Nobbenhuis MA, Meijer CJ, van den Brule AJ, et al (2001). Addition of high-risk HPV testing improves the current guidelines on follow-up after treatment for cervical intraepithelial neoplasia. Br J Cancer, 84, 796-801. https://doi.org/10.1054/bjoc.2000.1689
  10. Paraskevaidis E, Arbyn M, Sotiriadis A, et al (2004). The role of HPV DNA testing in the follow-up period after treatment for CIN: a systematic review of the literature. Cancer Treat Rev, 30, 205-11. https://doi.org/10.1016/j.ctrv.2003.07.008
  11. Rattanalappaiboon D, Kietpeerakool C, Kleebkaow P, et al (2014). Factors affecting compliance in the first year of postcolposcopy surveillance among women with a high incidence of cervical cancer. Int J Gynaecol Obstet, 124, 160-3. https://doi.org/10.1016/j.ijgo.2013.07.026
  12. Ryu A, Nam K, Kwak J, et al (2012). Early human papillomavirus testing predicts residual/recurrent disease after LEEP. J Gynecol Oncol, 23, 217-25. https://doi.org/10.3802/jgo.2012.23.4.217
  13. Sangkarat S, Ruengkhachorn I, Benjapibal M, et al (2014). Longterm outcomes of a loop electrosurgical excision procedure for cervical intraepithelial neoplasia in a high incidence country. Asian Pac J Cancer Prev, 15, 1035-9. https://doi.org/10.7314/APJCP.2014.15.2.1035
  14. Sigurdsson K (2013). Is a liquid-based cytology more sensitive than a conventional Pap smear? Cytopathology, 24, 254-63. https://doi.org/10.1111/cyt.12037
  15. Siriaunkgul S, Settakorn J, Sukpan K, et al (2014). Populationbased cervical cancer screening using high-risk HPV DNA test and liquid-based cytology in northern Thailand. Asian Pac J Cancer Prev, 15, 6837-42. https://doi.org/10.7314/APJCP.2014.15.16.6837
  16. Song SH, Lee JK, Oh MJ, et al (2006). Persistent HPV infection after conization in patients with negative margins. Gynecol Oncol, 101, 418-22. https://doi.org/10.1016/j.ygyno.2005.10.028
  17. Ueda Y, Enomoto T, Miyatake T, et al (2003). Monoclonal expansion with integration of high-risk type human papillomaviruses is an initial step for cervical carcinogenesis: association of clonal status and human papillomavirus infection with clinical outcome in cervical intraepithelial neoplasia. Lab Invest, 83, 1517-27. https://doi.org/10.1097/01.LAB.0000092234.68751.83
  18. Wright TC Jr, Cox JT, Massad LS, et al (2003). 2001 consensus guidelines for the management of women with cervical intraepithelial neoplasia. Am J Obstet Gynecol, 189, 295-304. https://doi.org/10.1067/mob.2003.633