Background: The follow-up schedule of women who have undergone treatment for high grade squamous intraepithelial lesions (HSIL) is a crucial part of the cervical screening programme. The ability to detect residual disease or early recurrence enables the provision of timely secondary intervention.
Aims: The aim of this study was to determine the prevalence of High Risk HPV and cytological abnormalities at first follow-up visit post treatment. The feasibility, safety and cost benefit of omitting routine colposcopy as a first line investigation were evaluated.
Methods: A total of 100 women with histologically confirmed and treated HSIL were recruited prior to first follow-up visit. Colposcopic assessment, cervical cytology using LBC and HR HPV testing was carried out on all women.
Results: In all, 75% of the study group had both a negative HR HPV test and a normal cervical cytology at first follow-up visit. Mean time interval to first follow-up was 9 months. The rate of residual/recurrent high-grade disease within this cohort was 4% followed up to 18 months post treatment. HR HPV had a sensitivity of 100% to detect persistent HSIL.
Conclusion: High-risk human papilloma virus testing in combination with cytology at first follow-up visit in women treated for HSIL has a very high sensitivity and negative predictive value. Colposcopy does not improve specificity in this cohort and could be omitted in patients who have a negative smear and HPV test.