Background: There is an emerging interest concerning the role HPV DNA testing in the follow-up period after conservative treatment for cervical intraepithelial neoplasia.
Methods: A MEDLINE and EMBASE search was done (1985 to March 2002), using the keywords HPV/HPV DNA, together with CIN, follow-up, recurrence and LLETZ. References of retrieved articles were also screened. Selection criteria were original published English-language reports of prospective or retrospective studies, including women with an initial diagnosis of cervical intraepithelial neoplasia, who received conservative surgical treatment and were followed with HPV DNA testing in addition to cytology, colposcopy and/or biopsy); the latter methods were used for verification of residual or recurrent disease.
Results: There is a marked heterogeneity in the design, population, intervention and follow-up policy across different studies. The sensitivity of HPV DNA testing in detecting treatment failures was quite good in most studies, reaching 100% in four of them, whereas the specificity of the test differed across the studies, ranging from 44% to 95%. Among women in whom the treatment was considered to be successful, 84.2% had a negative postoperative HPV DNA test and 15.8% a positive one. The corresponding rates for cases with treatment failures were 17.2% and 82.8%, respectively.
Conclusions: It seems that a positive HPV test, even in the presence of normal cytology, may pick up early and accurately a treatment failure. Cytology and colposcopy may still be needed in order to rule out false positive and false negative results.
Mini-abstract: A systematic review of studies concerning HPV DNA testing in the follow-up period after conservative treatment for cervical intraepithelial neoplasia indicates that a positive HPV test, even in the presence of normal cytology, may pick up early and accurately a treatment failure. Cytology and colposcopy may still be needed in order to rule out false positive and false negative results.