Performance of different follow-up strategies and genotype-based recurrence risk after treatment of cervical HSIL

Abstract

Abstract "Objective Our aim was to evaluate the performance of different follow-up strategies after treatment for cervical intraepithelial neoplasia (CIN) 2 or 3, including HPV detection, cytology, or colposcopy, as well as their combinations. Additionally, we compared the influence of the persistence of HPV16/18 versus that of other high-risk HPV genotypes (HR-HPV) in the recurrence risk. Material and Methods Retrospective register-based study, including women who had an excision of the transformation zone (ETZ) for CIN2 or CIN3 at our institution, between January 2011 and December 2022. The outcome assessed was histopathological recurrence/persistence of CIN2 or worse (CIN2+). Results Of the 721 women included, 6.8% (49/721) had recurrence/persistence. The sensitivity, specificity, positive and negative predictive values of the HPV test were 97.4%, 80%, 22.3%, and 99.8% respectively, whereas for co-testing (HR-HPV and cytology), 86.8%, 90.1%, 34.4%, and 99.1%, respectively. The referral rates for colposcopy were 24.3% and 14.2%, respectively. The sensitivity of colposcopy was low (40.0%). Women who were initially positive for non-16/18 genotypes at baseline who became HPV16/18 positive during follow-up, had a statistically significant increased risk of CIN2+, compared to those who tested positive only for other HR-HPV genotypes during both stages (hazard ratio=4.98; 95% CI: 1.66- 14.91). Conclusions HPV testing is the best strategy for follow-up after treatment of cervical HSIL. The addition of cytology triage decreases >40% the referrals for colposcopy, without significantly missing cases of recurrence/persistence. HPV16/18 in the follow-up, regardless of being previously positive, is associated with higher risk of recurrence/persistence of HSIL."