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Human papillomavirus test after conization in predicting residual disease in subsequent hysterectomy specimens
Jeong-Yeol Park1, Dae-Yeon Kim, Jong-Hyeok Kim
1From the Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Objective:
To estimate the effectiveness of the human papillomavirus (HPV) test performed after conization in predicting residual disease in patients who subsequently underwent hysterectomy.
Methods:
A total of 115 patients who underwent hysterectomy after conization caused by cervical intraepithelial neoplasia grade 3 (CIN 3) and microinvasive cervical cancer (IA1 cancer) were included in this prospective study. All patients underwent HPV testing with a liquid hybridization assay immediately before hysterectomy. Differences in sensitivity, specificity, and accuracy between resection margin and the HPV test in predicting residual disease in subsequent hysterectomy samples were estimated using the McNemar exact test.
Results:
Univariable analysis showed that age, parity, menopausal status, glandular extension, and severity of disease were not predictive for residual disease, but positive resection margin and positive HPV tests were significant factors for predicting residual disease. These factors were also significant in a multivariable analysis (positive resection margin 45.5%, odds ratio [OR] 3.09, 95% confidence interval [CI] 1.19-8.03, P=.021; positive HPV test 57.6%, OR 11.05, 95% CI 4.01-30.49, P<.001). With resection margin, the sensitivity, specificity, and accuracy in predicting residual disease were 75%, 53%, and 61%, respectively, whereas, with the HPV test, these values were 85%, 67%, and 73%, respectively (P=.454, .080, and .044, respectively). Of patients with positive resection margins, 79% of HPV-negative patients had no residual disease. Of patients with negative resection margins, no HPV-negative patient had residual disease.
Conclusion:
The HPV test after conization was significantly more accurate than resection margin for predicting residual disease. The predictive value of resection margin for predicting residual disease was much improved when used in combination with the HPV test. Use of the HPV test is recommended for identifying patients for subsequent hysterectomy after conization for CIN 3 and IA1 cancer.
Level Of Evidence:
III.