Introduction/Background Invasive Cervical Cancer (ICC) develops from Cervical Intraepithelial Neoplasia (CIN) and persistence of high-risk HPV (HR-HPV) infection represents the main risk factor for evolution of CIN into ICC. Prevention of the disease is based on two screening methods: Papanicolau Smear (Pap-test) and HPV test; the latter with higher sensitivity and lower specificity. HR-HPV positive test detects earlier than Pap-test high-grade CIN (CIN 2–3) at colposcopy-guided biopsy, but the subsequent conization often reveals the absence of an high-grade CIN. The objective of the present study is to assess the incidence of persistency of high-grade CIN at conization after a positive biopsy. Secondly we aimed to investigate the role of HPV genotypes in the evolution of the lesion, in order to better triage women at time of colposcopy.
Methodology A prospective study was conducted at Local Health Unit Toscana Centro and Careggi University Hospital (Florence, Italy) between January 2016 and February 2017 involving 308 women undergoing conization for high-grade CIN at cervical biopsy. All recruited patients underwent HPV testing prior conization. Biopsy and cone specimen data were recorded for each patient.
Results Only in half of the patients there was a persistency of high-grade CIN. Histology discrepancy between biopsy and cone was observed in 181 out of the 308 recruited patients (58.7%; p<0,001). There was evidence of a 37.4% of regression of CIN grade at cone, a 41.2% of stability and a 21.4% of progression. The overall evaluation of CIN evolution (regression, stability, progression) and HPV genotypes distribution showed a significant difference depending on HPV positive/negative samples (p<0.001), HPV risk (p=0.005) and genotype (p<0.001). HR-HPVs were highly represented in progression, being HPV16 genotype strikingly prevalent in this group, and significantly lower in patients with regression of the lesion.
Conclusion Approximately a third of patients with high-grade CIN at biopsy detected with Paptest and HPV screening underwent overtreatment with conization. Absent or LR HPV infection at time of conization were identified as predictors of regression. HPV test before conization could triage patients with high-grade CIN at cervical biopsy towards conisation or further follow-up with colposcopy.
Disclosures The authors declare that there is no conflict of interest.
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