Persistent human papilloma virus infection as an indicator of risk of recurrence of high-grade cervical intraepithelial neoplasia treated by the loop electrosurgical excision procedure.

OBJECTIVE

To evaluate the recurrence rate of high-grade cervical intraepithelial neoplasia (CIN) treated by the loop electrosurgical excision procedure (LEEP) according to the persistence of human papilloma virus (HPV) infection.

DESIGN

Prospective observational study.

SETTING

The Florence District screening program for cervical cancer.

SAMPLE

Eighty-four cases of CIN2/3 consecutively treated by LEEP and actively followed up.

METHOD

Cases underwent HPV testing (polymerase chain reaction) prior to LEEP and after 6 months, and then cyto-colposcopic followup every 6 months.

MAIN OUTCOMES MEASURES

Recurrence was defined as histological evidence of high-grade CIN. The association of recurrence to age and CIN grade at treatment and to cytologic and HPV test findings at recurrence was determined.

RESULTS

The average recurrence rate was 11.9% (10/84 cases; 95% CI, 5.9-20.8%). Recurrence probability was not significantly associated to age (chi2 = 0.25, df = 2, P = 0.88) or CIN grade (CIN 3 = 8/57, CIN2 = 2/27, chi2 = 0.26, df = 1, P = 0.6), whereas a significant association was evident for the cytology report (< LSIL = 6/76, HSIL > or = 4/8, chi2 = 8.55, df = 1, P = 0.003) and HPV testing (absent = 1/48, present = 9/36, chi2 = 8.23, df = 1, P= 0.004).

CONCLUSIONS

Most CIN2 > recurrences after LEEP occur in subjects with persistent HPV infection. Subjects with negative findings at cytology, colposcopy and HPV testing are at negligible risk of recurrence and might return safely to standard screening protocol.