J Low Genit Tract Dis. 2018 Feb 23. doi: 10.1097/LGT.0000000000000373. [Epub
ahead of print]

Effect of High-Risk Human Papillomavirus but Normal Cytology at Test of Cure on
Achieving Colposcopy Standards.

Kalampokas E(1), Wilson J, Gurumurthy M, Cruickshank ME.

Author information: 
(1)Department of Gynaecologic Oncology, Aberdeen Royal Infirmary, Aberdeen,
United Kingdom.

OBJECTIVE: In United Kingdom., test of cure after treatment of any grade of
cervical intraepithelial neoplasia (CIN) incorporates high-risk human
papillomavirus (Hr-HPV) test and cytology at 6-month follow-up. The aims of the
study were to determine the rate of recurrent CIN in women who are Hr-HPV
positive and cytology negative and to explore possible associated risk factors.
METHODS: A retrospective observational cohort study was performed in women
treated for any grade CIN between 2010 and 2015 from a regional population, who
were Hr-HPV positive and cytology negative at first follow-up.
RESULTS: A total of 2729 women were identified as treated for any grade CIN, and 
213 (7.8%) were re-referred to colposcopy having Hr-HPV-positive test and
negative cytology at test of cure. Their mean age was 31.56 years (range = 19-62 
years). The mean time of follow-up per woman was 30.50 months (range = 2-63
months). At colposcopy, 171 (80.3%) had colposcopy examination only and 42 women 
(19.7%) had a biopsy. Twenty-four cases (11.3%) of CIN were identified of which 4
(1.9%) were CIN 2/3. Eleven women (5.2%) in total had a repeat treatment. Five
women (2.3%) had biopsy-proven CIN 2/3 within 12-months after treatment. No cases
of CIN 3+ after negative colposcopy were identified during the follow-up period.
CONCLUSIONS: The incorporation of Hr-HPV testing yielded a very small number of
women with residual CIN within 12 months of treatment. Our results suggest that
women who are Hr-HPV positive and cytology negative after treatment of CIN with
normal and adequate colposcopy could be discharged to routine recall if confirmed
by larger national data.