J Gynecol Oncol.  2012 Oct;23(4):217-225. 10.3802/jgo.2012.23.4.217.

Early human papillomavirus testing predicts residual/recurrent disease after LEEP

• Ryu A
• Nam K
• Kwak J
• Kim J
• Jeon S

• KMID: 1810118
• DOI: http://doi.org/10.3802/jgo.2012.23.4.217

Abstract

OBJECTIVE
The purpose of this study was to determine the predictive factors for residual/recurrent disease and to analyze the timing for Pap smears and human papillomavirus (HPV) testing during follow-up after loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia (CIN) 2 or worse.
METHODS
We retrospectively analyzed 183 patients (mean age, 39.3 years) with CIN 2/3 who were treated with LEEP. Post-LEEP follow-up was performed by Pap smear and HPV hybrid capture2 (HC2) testing. The definition of persistent/recurrent disease was biopsy-proven CIN 2 or worse.
RESULTS
Among 183 patients, punch biopsies were CIN 2 in 31 (16.9%) and CIN 3 in 152 (83.1%). HPV HC2 tests before LEEP were positive in 170 (95.5%) of 178 patients. During follow-up, 12 patients (6.6%) had residual/recurrent CIN 2+. LEEP margin status was a significant predictive factor for persistent/recurrent disease. Other factors such as age, HPV HC2 viral load (> or =100 relative light units), and HPV typing (type 16/18 vs. other types) did not predict recurrence. Early HPV HC2 testing at 3 months after LEEP detected all cases of residual/recurrent disease. The sensitivity and negative predictive value of the HPV HC2 test for residual/recurrent disease were both 100% at 3 and 6 months.
CONCLUSION
Margin involvement in conization specimens was a significant factor predicting residual/recurrent disease after LEEP. HPV test results at 3 and 6 months after treatment were comparable. Early 3-month follow-up testing after LEEP can offer timely information about residual/recurrent disease and alleviate patient anxiety early about treatment failure.

Keyword

Cervical intraepithelial neoplasia; Follow-up; Human papillomavirus; Loop electrosurgical excision procedure

MeSH Terms

Anxiety
Biopsy
Cervical Intraepithelial Neoplasia
Chimera
Conization
Follow-Up Studies
Humans
Light
Recurrence
Retrospective Studies
Treatment Failure
Viral Load

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