Addition of high-risk HPV testing improves the current guidelines on follow-up after treatment for cervical intraepithelial neoplasia

We assessed a possible role for high-risk human papillomavirus (HPV) testin g in the policy after treatment for cervical intraepithelial neoplasia (CIN ) 2 or 3 (moderate to severe dysplasia). According to the Dutch guidelines follow-up after treatment consists of cervical cytology at 6, 12 and 24 mon ths. Colposcopy is only performed in case of abnormal cervical cytology. In this observational study 184 women treated for CIN 2 or 3 were prospective ly monitored by cervical cytology and high-risk HPV testing 3, 6, 9, 12 and 24 months after treatment. Post-treatment CIN 2/3 was present in 29 women (15.8%). A positive high-risk HPV test 6 months after treatment was more pr edictive for post-treatment CIN 2/3 than abnormal cervical cytology (sensit ivity 90% and 62% respectively, with similar specificity). At 6 months the negative predictive value of a high-risk HPV negative, normal smear, was 99 %. Largely overlapping, partly different groups of women with post-treatmen t CIN 2/3 were identified by HPV testing and cervical cytology. Based on th ese results we advocate to include highrisk HPV testing in monitoring women initially treated for CIN 213. In case of a high-risk HPV positive test or abnormal cervical cytology, colposcopy is indicated. Ail women should be t ested at 6 and 24 months after treatment and only referred to the populatio n-based cervical cancer screening programme when the tests are negative on both visits. (C) 2001 Cancer Research Campaign http://www.bjcancer.com.