Cervical Cytology and HPV Test in Follow-up after Conisation or LLETZReport as inadecuate

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Collegium antropologicum, Vol.34 No.1 March 2010. -

The patients treated with conservative surgical therapy for cervical intraepithelial neoplasia CIN have an increased risk to develop invasive cervical carcinoma compared to the general population. Cervical cytology and HPV test are included in the protocols for the detection of treatment failure. The purpose of the study was to analyse cytology-histology correlation after conisation or Large Loop Excision of the Transformation Zone LLETZ, resection margin status, compliance to the follow-up protocol and evaluation of cervical cytology and HPV testing in two year period after surgical treatment. We retrospectively reviewed 251 cases of conisation or LLETZ performed between January and December, 2006. Conventional cervical smears were analysed and abnormal cytology was defined as atypical squamous cells of undetermined significance or worse ASCUS+. The digene Hybrid capture 2 test was used for detection of high-risk HPV types. Histology analysis demonstrated CIN1+ lesion in 234 cases 93.2% with cytology-histology correlation in 97.9% of cases. A preoperative HPV test was made in 142 histologically confirmed CIN1+ lesions and 137 96.5% tested positive. The resection margins were involved in 48 20.8% cases. In 24 10.3% cases the margins were difficult to determine. Abnormal cytology was found in 33 15.2% cases of the 217 86.5% patients that attended the post-treatment visits. The post-treatment HPV test was performed on 159 women and it was positive in 25 15.7% cases. The complete follow-up control cytology, with at least three Pap smears in the subsequent two years or with second treatment, was registered in only 146 58.2% patients. 14-217 6.5% patients underwent second treatment with histologically confirmed treatment failure. In all patients with control smear, repeated cytology found HSIL. On six women, the control HPV test was performed. In five cases, it was positive and in one case with histological diagnoses of VAIN2, it was negative. Our study confirms the important role of cervical cytology in the diagnosis of cervical intraepithelial lesions and monitoring after treatment. In the future we will have to improve compliance to the follow-up protocols and use of the HPV test in the selection of women at risk of treatment failure.

cervical intraepithelial neoplasia; cervical cytology; human papillomavirus; conisation; LLETZ; follow-up

Author: Damjana Verša Ostojić - ; Department of Gynecological Cytology, Department of Gynecology and Obstetrics, University Hospital Ce

Source: http://hrcak.srce.hr/


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