HPV genotyping among women treated for high-grade cervical intraepithelial neoplasia with no lesion in the conization specimen.

OBJECTIVE: To evaluate whether specific HPV genotypes or multiple HPV infection are associated with absence of cervical intraepithelial neoplasia (CIN) in the conization specimen. METHODS: In a retrospective study, data were reviewed for women treated by conization at a center in Barcelona, Spain, between 2008 and 2011. Women whose pretreatment biopsy showed CIN2/3 with positive p16 staining but had no lesions in the conization specimen were included in the study group if material was sufficient for HPV genotyping. Age-matched control patients who had CIN2/3 in the conization specimen were selected. HPV genotyping was conducted on all histologic specimens. RESULTS: Both groups contained 43 patients. High-risk HPV genotypes were identified in the conization specimens of 14 (33%) women in the study group and of 42 (98%) in the control group (P<0.001). HPV16/HPV18 was detected in the pretreatment biopsy samples of 27 (63%) women in the study group and 25 (58%) in the control group (P=0.413). Multiple HPV infections were detected pretreatment in 8 (19%) women in the study group and 9 (21%) in the control group (P=0.50). CONCLUSION: No association was found between HPV genotype or multiple HPV infection and absence of lesion in the conization specimen.

Predictors of absence of cervical intraepithelial neoplasia in the conization specimen.

OBJECTIVE: Over 10% of women who undergo conization for cervical intraepithelial neoplasia (CIN) show no lesion in the surgical specimen. We aimed to determine whether these patients can be identified before conization using clinical, virological and/or cyto-histological characteristics, to avoid unnecessary treatment. METHODS: Of 687 women with CIN treated by conization in the Hospital Clinic of Barcelona between 2008 and 2011, all patients (n=110, 16%) showing no lesion in the surgical specimen were included as the study group. The control group included a series of randomly selected women with CIN in the cone specimen (n=220). Pre-conization clinical characteristics as well as high-risk human papillomavirus (hr-HPV) status determined by Hybrid Capture 2 were analyzed as possible predictors of absence of lesion. RESULTS: A negative pre-conization hr-HPV test or a low viral load (<10 relative light units) significantly increased the probability of absence of CIN in the conization specimen (75.0%, and 52% respectively) compared with patients with a high viral load (26.7%, p<0.001). This association was confirmed in the multivariate analysis (p<0.001). The risk of developing persistent/recurrent disease after treatment was significantly lower in patients with negative hr-HPV test or a low viral load (16.1% CIN1, 0% CIN2-3), than in patients with a high viral load (27.6% CIN1, 4.1% CIN2-3, p=0.031). CONCLUSION: Women with negative pre-conization hr-HPV test results or a low viral load have a high probability of having no lesion in the conization specimen. These patients should be excluded from immediate surgical excision and considered for follow-up.