[Guidelines for the follow-up of women treated for high-grade cervical neoplasia]

The women treated for CIN2-3 remain at a substantially increased risk of recurrences, which persists longer than 10 years. The women treated for a CIN2-3 are more likely to develop invasive cancer and the risk is two to five times greater than that of the general population. The main objective of the follow-up of patients treated for high-grade CIN is in one hand, to detect and treat the recurrences and on the other hand, to determine a subpopulation presenting a high risk of recurrence which should be followed-up more intensively. At present, frequent follow-up with cytology and colposcopic evaluation of the cervix is the preferred strategy recommended in France by Anaes. Both, the cytology and the colposcopy don't have a very good sensitivity. HPV test is more sensitive compared to cytology or colposcopy in detecting CIN treatment failures. It would be more prudent to use a strategy involving both the cytology and HPV test. Both the sensitivity and the negative predictive value of combined cytology and HPV testing in detecting a residual disease or recurrence are around 100%. Women presenting negative results of both tests, could, then be considered at a low risk of recurrence and their surveillance should be the same as that of the screening of the general population. In case of positivity a more intensive follow-up should be organized.