Pap Smear Combined with HPV Testing: A Reasonable Tool for Women with High-grade Cervical Intraepithelial Neoplasia Treated by LEEP

Abstract

<b>Background:</b> To evaluate HPV testing by Hybrid Capture II (HCII) in conjunction with cytology in detectingthe residual/recurrence disease after treatment of high-grade cervical intraepithelial neoplasia (CIN II-III) withloop electrosurgical excision procedure (LEEP). Materials and <br/><b>Methods</b>: A retrospective review of 158 patientswith histologically confirmed CIN II-III who underwent LEEP between January 2011 and October 2012 wasconducted. Post-treatment control was scheduled at the 3rd, 6th, 12th and 18th month. All patients were followedup by Pap smear and HR-HPV genotype and viral load testing. <br/><b>Results</b>: Pre-treatment, HR-HPV DNA, wasdetected in all specimens of the patients. At follow-up, 25 patients were diagnosed as the residual/recurrent diseaseduring the FU visit, among whom, 16 patients with positive margin: 13 patients (52%) with HR-HPV DNA+/cytology+, 2 patients (8%) with HR-HPV DNA+/cytology-, 1 patient (4%) with cytology+/ HR-HPV DNA-; 9patients with clean margin – 5 patients (55.6%) with HR-HPV DNA+/cytology+; 2 patients (22.2%) with HRHPVDNA+/cytology-, 2 patients (22.2%) with cytology+/ HR-HPV DNA-. None of them persisting HR-HPVDNA-/cytology- with positive or negative margin was identified as the residual/recurrent disease. The majorityof residual/recurrent disease was detected at the 12th and 18th month FU, and there was almost no differencein the sensitivity and negative predictive value (NPV) between at the 3rd month and the 6th month FU visits. 14residual/recurrence disease (14/46:30.4%) had pre-treatment high viral load (>5 000 RUL/PC) and 11 (11/112,9.8%) with pre-treatment low viral load, P<0.05. <br/><b>Conclusions</b>: (1) The persistence HR-HPV DNA is the rootcause of the residual/recurrent disease for the women treated for high-grade CIN; the pre-treatment viral loadand margin can be seen as the predictor. (2) The FU visit beginning at the 6th month post-treatment and lastingat least 24 months with the combination of cytology and HPV testing. (3) Patients with high pre-treatment HPVload, which is considered as one risk of developing the residual/recurrent disease, should be paid more attention(especially above 500RUL/PC) to by clinicians.