HPV testing as an adjunct to cytology in the follow up of women treated for cervical intraepithelial neoplasia


Prof HC Kitchener, Academic Unit of Obstetrics and Gynaecology, St Mary’s Hospital, Manchester M13 0JH, UK. Email henry.kitchener@cmmc.nhs.uk


Objective  To evaluate human papillomavirus (HPV) testing in combination with cytology in the follow up of treated women.

Design  A prospective study.

Setting  Three UK centres: Manchester, Aberdeen and London.

Population or sample  Women treated for cervical intraepithelial neoplasia (CIN).

Methods  Women were recruited at 6 months of follow up, and cytology and HPV testing was carried out at 6 and 12 months. If either or both results were positive, colposcopy and if appropriate, a biopsy and retreatment was performed. At 24 months, cytology alone was performed.

Main outcome measures  Cytology and histology at 6, 12 and 24 months.

Results  Nine hundred and seventeen women were recruited at 6 months of follow up, with 778 (85%) and 707 (77.1%) being recruited at 12 and 24 months, respectively. At recruitment, 700 women had had high-grade CIN (grades 2 or 3) and 217 had CIN1. At 6 months, 14.6% were HPV positive and 10.7% had non-negative cytology. Of those with negative cytology, 9% were HPV positive. Of the 744 women who were cytology negative/HPV negative at baseline, 3 women with CIN2, 1 with CIN3, 1 with cancer and 1 with vaginal intraepithelial neoplasia (VAIN)1 were identified at 24 months. Nine of 10 cases of CIN3/cervical glandular intraepithelial neoplasia (CGIN) occurred in HPV-positive women. At 23 months, cancer was identified in a woman treated for CGIN with clear resection margins, who had been cytology negative/HPV negative at both 6 and 12 months.

Conclusions  Women who are cytology negative and HPV negative at 6 months after treatment for CIN can safely be returned to 3-year recall.