HPV testing and monitoring of women after treatment of CIN 3: Review of the literature and meta-analysis

According to the current guidelines in most western countries, women treated for cervical intraepithelial neoplasia grade 3 (CIN 3) are followed for at least 2 years after treatment by cytology. High-risk human papillomavirus (hrHPV) infections are necessary for the development and maintenance of CIN 3. HrHPV testing could be used to improve monitoring of women treated for CIN 3. This has prompted numerous studies for the implementation of hrHPV testing in monitoring of women treated for CIN 3. Included in this review are 20 studies, published between 1996 and 2003, comparing hrHPV testing with either resection margins or cervical cytology to predict recurrent/residual disease, and 11 of them could be used in a meta-analysis. In the meta-analysis of the 11 studies,the negative predictive value (NPV) for recurrent/residual disease of hrHPV testing was 98% (95% Cl 97-99%), that of resection margins 91% (95% CI 87-94%), and that of cervical cytology 93% (95% Cl 90-95%). When hrHPV testing was performed in conjunction with cytology, the sensitivity was 96% (95% Cl 89-09%), specificity was 81% (95% CI 77-84%), the associated positive predictive value (PPV) was 46% (95% Cl 38-64%), and the NPV was 99% (95% Cl 98-100%). Combined hrHPV and cytology testing yielded the best test characteristics. We propose to include hrHPV testing in conjunction with cytology for monitoring women treated for CIN 3. Some follow-up visits for women testing negative for both hrHPV and cytology can be skipped. In western countries, this could mean that for women double negative at 6 months, retesting at 12 months should be skipped while keeping the 24-month follow-up visit. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to describe the various types of HPV detection systems, to compare the various HPV detection methods against the currently available methods of monitoring, and to outline a potential post-treatment management plan for patients treated for HPV-associated cervical neoplasia.