HPV determination in the control after LEEP due to CIN II-III: prospective study and predictive model

To evaluate the usefulness of the endocervical cytology immediately after loop electrosurgical excision procedure (LEEP) and viral human papilloma virus (HPV) determination as predictive factors of persistence/recurrence (P/R) of squamous intraepithelial lesion (SIL) in the remaining cervix of patients treated with LEEP due to cervical intraepithelial neoplasia (CIN) II or III. We retrospectively selected 105 samples from 100 patients with histologic diagnosis of CIN II-III with cytology immediately after LEEP with a first control post-LEEP between 2 and 6 months after treatment that included HPV determination, a minimal follow-up period of 12 months and maximum of 24 months, and at least 2 colpocytologic controls post-LEEP. In 71 of the 105 patients (67.6%), the determination was negative, finding the presence of HPV in 34 patients (32.4 %). Almost two-thirds of the patients had negative endocervical cytology and absence of HPV. During the follow-up, 20 P/R were detected, 16 (15.2%) of them being high-grade squamous intraepithelial lesions (7 CIN II and 9 CIN III). The combination of endocervical cytology and HPV determination in the remaining cervix seems to be a good strategy to predict the risk of SIL after conization. The probability of P/R can be estimated based on the results of these 2 variables. The negativity of HPV determination together with a negative endocervical cytology guarantees enough security and a favorable evolution.