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Gynecol Oncol. 2014 Dec;135(3):468-73. doi: 10.1016/j.ygyno.2014.09.022. Epub 2014 Oct 2.

Value of endocervical margin and high-risk human papillomavirus status after conization for high-grade cervical intraepithelial neoplasia, adenocarcinoma in situ, and microinvasive carcinoma of the uterine cervix.

Author information

1
Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea.
2
Department of Pathology, Ajou University School of Medicine, Suwon, Republic of Korea.
3
Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea. Electronic address: hsryu@ajou.ac.kr.

Abstract

OBJECTIVE:

The aim of this study was to analyze clinico-pathologic factors and the optimal cut-off value of high-risk human papillomavirus (HR-HPV) viral load for predicting high-grade residual/recurrent disease after the conization in cervical intraepithelial neoplasia (CIN 2-3), adenocarcinoma in situ (AIS), and microinvasive carcinoma of the uterine cervix (MICA).

METHODS:

We retrospectively reviewed data from 701 patients with CIN 2-3, AIS, and MICA who underwent conization between September 2003 and June 2012. Receiver-operating characteristic curve analysis was used to find out the cut-off value of HR-HPV viral load for predicting residual/recurrent disease. Clinico-pathologic variables, including resection margin and HR-HPV status, were evaluated as possible predictors of residual/recurrent disease.

RESULTS:

At a cut-off value of 1.16 RLU/CO for post-cone HR-HPV viral load, the sensitivity was 88.2% and the specificity was 98.3%. Multivariate analysis demonstrated that post-cone cytology (p=0.001, OR=83.808, 95% CI=6.688-1050.232), endocervical margin status (p<0.001, OR=80.478, 95% CI=7.421-872.732), and post-cone HR-HPV status (p<0.001, OR=79.660, 95% CI=8.539-743.129) were significantly associated with residual/recurrent disease. The post-cone HR-HPV positivity was observed more in the patients who showed positive endocervical margin than in the patients with positive ectocervical margin (32.6% vs. 5.3%, p=0.002).

CONCLUSIONS:

Follow-up using liquid based cytology in combination with HR-HPV test at 12 months after the conization, and not the early HR-HPV test, might be acceptable. Post-cone endocervical margin status combined with post-cone HR-HPV test is critical for predicting residual/recurrent disease and clinical management.

KEYWORDS:

Cold knife conization; Endocervical margin; HR-HPV viral load; Residual/recurrent disease

PMID:
25284039
DOI:
10.1016/j.ygyno.2014.09.022
[Indexed for MEDLINE]

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