Objectives 1. To determine the role of HPV testing after excisional treatment of cervical precancer. 2. To determine clinical factors associated with persistence of cervical precancer post-treatment.

Methods A retrospective chart review was conducted on patients who had a LEEP for cervical precancer (CIN3/AIS/HSIL) between 2016–2018 at a colposcopy unit in a university-affiliated centre in Toronto. Persistence/recurrence of disease was defined as a finding of high-grade cytology or pathology results during the time of follow-up. Univariate and multivariate regression models were run with persistence/recurrence and HPV positivity at exit testing as an outcome.

Results A total of 284 patients were included. The median follow-up time was 19 months. Of the LEEP specimens, 90.8% (n=258) demonstrated HSIL and 3.9% (n=11) had AIS. 28.5% (n=81) of the LEEP specimens had positive margins. In follow-up, 72.9% had negative cytology, 17.6% had ASCUS/LSIL, 1.8% had ASC-H/LSIL-H and 6.7% had HSIL. At the final follow-up, 27.8% (n=79) were HPV+. Overall rate of persistence/recurrence was 11.3% (n=32); median time to persistence/recurrence was 6.5 months. Multivariate regression models demonstrated that follow-up HPV positivity (OR=22.0) and positive margins (OR=3.7) were significant for predicting persistence/recurrence. Similarly, in univariate regression models, positive margins were significant (OR=2.2) for predicting HPV positivity in exit testing.

Conclusions Persistence/recurrence of precancer can occur due to incomplete treatment of lesions by local excision and by persistence of HPV infection. Surveillance strategies for women treated for cervical precancer require a risk-based approach such as that suggested in the ASCCP guidelines.