Evaluating Efficacy of Cervical HPV-HR DNA Testing as Alternative to PET/CT Imaging for Posttreatment Cancer...

High-risk human papillomaviruses (HPV-HR) are implicated in more than 99% of cervical/vaginal malignancies. Despite this strong association, current guidelines recommend PET/CT imaging over HPV-HR DNA testing as the standard prognostic tool following definitive therapy. This retrospective, single-institution, proof-of-concept study evaluated HPV-HR DNA testing as a potential alternative to PET/CT imaging for posttreatment surveillance in cervical and vaginal cancers.

Female patients with cervical or vaginal cancer treated between 2010 and 2023 at our institution were retrospectively analyzed. Eligible patients had complete documentation of pre- and posttreatment PET/CT imaging and HPV-HR DNA testing. Of more than 100 patients identified, only 53 met the inclusion criteria, and both radical hysterectomy and chemoradiation patients were included. Statistical analyses, including sensitivity, specificity, and predictive values, were conducted using Stata, with significance set at 0.05.

Posttreatment HPV-HR DNA testing demonstrated a superior sensitivity (92.31%) and negative predictive value (97.44% NPV) compared with PET/CT imaging (76.92% sensitivity and 92.31% NPV). Although PET/CT imaging maintained higher specificity over HPV-HR DNA testing (100% vs. 95%) and positive predictive value (100% vs. 85.71%), HPV-HR DNA testing offers a more sensitive and cost-effective method for identifying patients requiring further evaluation.

HPV-HR DNA testing is a promising, cost-effective surveillance tool with higher sensitivity and NPV than PET/CT. Its clinical use may reduce PET/CT need, improve safety, and lower costs and require further validation.

HPV-HR DNA testing offers a cost-effective alternative to PET/CT, reducing costs, unnecessary imaging, and improving accessibility.