Accuracy of human papillomavirus testing in detecting persistent or recurrent disease at follow-up after conization

Currently, the Test of Cure after conization consists of two elements, namely human papillomavirus (HPV) testing and cytology. Given the high sensitivity of HPV testing and its modest resource requirements, we will explore its potential as a stand-alone test for identifying persistent/recurrent cervical intraepithelial neoplasia (CIN) during follow-up after conization, including women at increased risk, such as those with involved resection margins.

This retrospective study examined 473 women who underwent conization in Funen, Denmark, between January 1, 2020, and December 31, 2024. During the post-conization follow-up period, data were manually extracted from patients' medical records and PatoBank.

At the follow-up, cervical intraepithelial neoplasia grade 1 or worse (CIN1+) persistent/recurrence was experienced by 55 women (11.6%) (median age of 42 years (range 22-87 years)). Among those with involved margins, 30.3% (40/132) experienced persistent/recurrent CIN1+ compared to 3.6% (7/193) with free margins; and 66.4% (314/473) tested negative for high-risk HPV after conization, and only four of them developed persistent/recurrent CIN1+. HPV testing alone predicted the risk of CIN1+ persistence/recurrence with 93% sensitivity and 98.7% negative predictive value (NPV). Combining negative HPV test results with free resection margins yielded a sensitivity and NPV of 100%. Co-testing combined with free margins also provided a sensitivity and NPV of 100%.

Using HPV testing as a stand-alone test after conization demonstrates an NPV nearly equal to that of the Test of Cure. Adding free margins to HPV testing further enhanced sensitivity and NPV for detecting CIN1+ persistence or relapse during follow-up. Our results indicate that HPV testing alone can be used as post-conization follow-up for women with negative margins.