Mo Ling-Zhao, Song Hong-Lin, Wang Jian-Li, He Qing, Qiu Zhang-Can, Li Fei
Department of Gynecological Oncology, Tumor Hospital Affiliated to Guangxi Medical University, Nanning, Guangxi, China E-mail :
Asian Pac J Cancer Prev. 2015;16(10):4297-302. doi: 10.7314/apjcp.2015.16.10.4297.
To evaluate HPV testing by Hybrid Capture II (HCII) in conjunction with cytology in detecting the residual/recurrence disease after treatment of high-grade cervical intraepithelial neoplasia (CIN II-III) with loop electrosurgical excision procedure (LEEP).
A retrospective review of 158 patients with histologically confirmed CIN II-III who underwent LEEP between January 2011 and October 2012 was conducted. Post-treatment control was scheduled at the 3rd, 6th, 12th and 18th month. All patients were followed up by Pap smear and HR-HPV genotype and viral load testing.
Pre-treatment, HR-HPV DNA, was detected in all specimens of the patients. At follow-up, 25 patients were diagnosed as the residual/recurrent disease during the FU visit, among whom, 16 patients with positive margin: 13 patients (52%) with HR-HPV DNA+/cytology+, 2 patients (8%) with HR-HPV DNA+/cytology-, 1 patient (4%) with cytology+/ HR-HPV DNA-; 9 patients with clean margin--5 patients (55.6%) with HR-HPV DNA+/cytology+; 2 patients (22.2%) with HR- HPV DNA+/cytology-, 2 patients (22.2%) with cytology+/HR-HPV DNA-. None of them persisting HR-HPV DNA-/cytology- with positive or negative margin was identified as the residual/recurrent disease. The majority of residual/recurrent disease was detected at the 12th and 18th month FU, and there was almost no difference in the sensitivity and negative predictive value (NPV) between at the 3rd month and the 6th month FU visits. 14 residual/recurrence disease (14/46:30.4%) had pre-treatment high viral load (>5,000 RUL/PC) and 11 (11/112, 9.8%) with pre-treatment low viral load, P<0.05.
(1) The persistence HR-HPV DNA is the root cause of the residual/recurrent disease for the women treated for high-grade CIN; the pre-treatment viral load and margin can be seen as the predictor. (2) The FU visit beginning at the 6th month post-treatment and lasting at least 24 months with the combination of cytology and HPV testing. (3) Patients with high pre-treatment HPV load, which is considered as one risk of developing the residual/recurrent disease, should be paid more attention (especially above 500 RUL/PC) to by clinicians.
评估杂交捕获二代（HCII）HPV检测联合细胞学检查在检测经环形电切术（LEEP）治疗的高级别宫颈上皮内瘤变（CIN II - III）后残留/复发性疾病中的应用。
回顾性分析2011年1月至2012年10月间158例经组织学确诊为CIN II - III并接受LEEP治疗的患者。治疗后分别于第3、6、12和18个月进行复查。所有患者均接受巴氏涂片、高危型人乳头瘤病毒（HR - HPV）基因型及病毒载量检测。
治疗前，所有患者标本均检测到HR - HPV DNA。随访期间，25例患者在随访时被诊断为残留/复发性疾病，其中，切缘阳性的16例患者中：13例（52%）HR - HPV DNA阳性/细胞学阳性，2例（8%）HR - HPV DNA阳性/细胞学阴性，1例（4%）细胞学阳性/HR - HPV DNA阴性；切缘阴性的9例患者中：5例（55.6%）HR - HPV DNA阳性/细胞学阳性，2例（22.2%）HR - HPV DNA阳性/细胞学阴性，2例（22.2%）细胞学阳性/HR - HPV DNA阴性。切缘阳性或阴性且持续HR - HPV DNA阴性/细胞学阴性的患者均未被诊断为残留/复发性疾病。大多数残留/复发性疾病在随访第12和18个月时被检测到，在第3个月和第6个月随访时的敏感性和阴性预测值（NPV）几乎没有差异。14例残留/复发性疾病（14/46，30.4%）治疗前病毒载量高（>5,000 RUL/PC），11例（11/112，9.8%）治疗前病毒载量低，P<0.05。
（1）持续性HR - HPV DNA是高级别CIN治疗后女性残留/复发性疾病的根本原因；治疗前病毒载量和切缘可作为预测指标。（2）治疗后第6个月开始随访，持续至少24个月，联合细胞学和HPV检测。（3）治疗前HPV载量高的患者被认为是发生残留/复发性疾病的风险之一，临床医生应给予更多关注（尤其是病毒载量>500 RUL/PC时）。
