Human papillomavirus testing and the outcome of treatment for cervical intraepithelial neoplasia

Objective: To investigate whether human papillomavirus (BPV) testing could be used in the follow-up after large loop excision of the transformation zo ne (LLETZ) for cervical intraepithelial neoplasia (CIN). Methods: We performed a retrospective study of 41 women who developed subse quent CIN after LLETZ (group A) and 82 women without CIN for a minimum of 5 years after LLETZ (group B). The first post-treatment cervical smear was r etrieved and examined for high-risk BPV deoxyribonucleic acid. The sensitiv ity, specificity, positive and negative likelihood ratio of HPV testing, fi rst post-treatment Papanicolaou. test, and excision margins for the detecti on of treatment failure were calculated. Multiple logistic regression analy sis was also done. Results: The BPV test was positive in 38 of 41 women in group A and 13 of 8 2 in group B (P<.001). An abnormal cytologic result in the first post-treat ment smear was found in 20 of 41 in group A and 11 of 82 in group B (P<.001 ). Sixteen women in group A and 18 in group B had involved margins (P=.046) . Values for the sensitivity, specificity, and positive and negative likeli hood ratios of the HPV test were 93% 84%, 5.8, 0.08; for die Papanicolaou t est they were 49%, 87%, 3.9, 0.586; and for margin status they were 39%, 78 %, 1.8, 0.782, respectively. Positive HPV test presents significantly high odds ratio for treatment failure (P<.001), independent of cytology and marg in status. Conclusion: Women who postoperatively have positive HPV testing are at high er risk of treatment failure. This could be performed at die first post-tre atment visit and further follow-up could be adjusted accordingly. (Obstet G ynecol 2001;98:833-6. (C) 2001 by the American College of Obstetricians and Gynecologists.).