Value of endocervical margin and high-risk human papillomavirus status after conization for high-grade cervical intraepithelial neoplasia, adenocarcinoma in situ, and microinvasive carcinoma of the uterine cervix.

Abstract

OBJECTIVE: The aim of this study was to analyze clinico-pathologic factors and

the optimal cut-off value of high-risk human papillomavirus (HR-HPV) viral load

for predicting high-grade residual/recurrent disease after the conization in

cervical intraepithelial neoplasia (CIN 2-3), adenocarcinoma in situ (AIS), and

microinvasive carcinoma of the uterine cervix (MICA). METHODS: We retrospectively

reviewed data from 701 patients with CIN 2-3, AIS, and MICA who underwent

conization between September 2003 and June 2012. Receiver-operating

characteristic curve analysis was used to find out the cut-off value of HR-HPV

viral load for predicting residual/recurrent disease. Clinico-pathologic

variables, including resection margin and HR-HPV status, were evaluated as

possible predictors of residual/recurrent disease. RESULTS: At a cut-off value of

1.16 RLU/CO for post-cone HR-HPV viral load, the sensitivity was 88.2% and the

specificity was 98.3%. Multivariate analysis demonstrated that post-cone cytology

(p=0.001, OR=83.808, 95% CI=6.688-1050.232), endocervical margin status (p<0.001,

OR=80.478, 95% CI=7.421-872.732), and post-cone HR-HPV status (p<0.001,

OR=79.660, 95% CI=8.539-743.129) were significantly associated with

residual/recurrent disease. The post-cone HR-HPV positivity was observed more in

the patients who showed positive endocervical margin than in the patients with

positive ectocervical margin (32.6% vs. 5.3%, p=0.002). CONCLUSIONS: Follow-up

using liquid based cytology in combination with HR-HPV test at 12 months after

the conization, and not the early HR-HPV test, might be acceptable. Post-cone

endocervical margin status combined with post-cone HR-HPV test is critical for

predicting residual/recurrent disease and clinical management.