Prediction of recurrent disease by cytology and HPV testing after treatment of cervical intraepithelial neoplasia

Document Type



Obstetrics and Gynaecology (East Africa)


Objective: To assess the role of human papillomavirus (HPV) testing and cytology as predictors ofresidual⁄recurrent disease after treatment of high-grade cervical intraepithelial lesions.

Methods: One hundred and thirty-eight women with cervical intraepithelial neoplasia (CIN) grade 2⁄3 lesionon biopsy were included in a prospective follow-up study in Belgium and Nicaragua. All women were treatedwith loop electrosurgical excision procedure (LEEP) and follow-up visits took place at 6 weeks, 6 months, 1 yearand 2 years. During these visits, a Papanicolaou (Pap) smear test was taken, colposcopy was performed andspecimens were collected for HPV testing. Cytology, high-risk (HR) HPV presence, persistent HR HPV infectionand combinations of these tests at different time points during follow-up were correlated with histologicallyconfirmed residual⁄recurrent disease.

Results: Thirteen patients (9%) developed residual⁄recurrent disease during follow-up. Abnormal cytol-ogy at 6 weeks after treatment was significantly correlated with residual⁄recurrent disease. Nine ofthirty-seven patients with abnormal cytology at 6 weeks had recurrent disease versus three of seventy with anormal cytology [odds ratio (OR): 7.2; 95% confidence interval (CI): 1.8–28.5;P= 0.003). Sensitivity ofthis test was 75.0%, specificity 70.5%. Combining abnormal cytology and the presence of HR HPV withinthe first 6 months after treatment gave the best correlation with residual⁄recurrent disease: of the 54women with abnormal cytology and⁄or HR HPV presence within the first 6 months, 11 developedresidual⁄recurrent disease (OR 10.2; 95% CI: 2.2–48.3). Sensitivity of this combination was 84.6% andspecificity 65.0%.

Conclusion: Cytology remains the cornerstone in the early follow-up after LEEP for CIN lesions of the cervix.HPV testing can add value as it increases the sensitivity of cytology in concomitant testing within the first6 months.


This work was published before the author joined Aga Khan University.