HPV testing as an effective triage strategy in the follow-up after fertility-sparing treatment for glandular lesions of the uterine cervix

Lukas Dostalek; Pavel Freitag; Miroslava Slovackova; Tomas Zima; Martin Komarc; Lenka Fricova; Tomas Fucik; Kristyna Nemejcova; David Cibula; Daniel Brynda; Jiri Slama

doi:10.1136/ijgc-2023-004920

HPV testing as an effective triage strategy in the follow-up after fertility-sparing treatment for glandular lesions of the uterine cervix

Int J Gynecol Cancer. 2023 Dec 2:ijgc-2023-004920. doi: 10.1136/ijgc-2023-004920. Online ahead of print.

Authors

Affiliations

¹ Department of Obstetrics, Gynecology and Neonatology, First Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic.
² Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic.
³ Institute of Biophysics and Informatics, First Faculty of Medicine of Charles University in Prague, Prague, Czech Republic.
⁴ Department of Pathology, First Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic.
⁵ Department of Obstetrics, Gynecology and Neonatology, First Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic Jiri.Slama@vfn.cz.

PMID: 38054269
DOI: 10.1136/ijgc-2023-004920

Abstract

Objective: The management and surveillance of glandular pre-cancerous lesions of the uterine cervix present distinct challenges compared with squamous lesions, primarily attributed to the lower effectiveness of diagnostic methods such as cytology or colposcopy. This study aimed to investigate the long-term safety of fertility-sparing treatment for adenocarcinoma in situ and microinvasive adenocarcinoma of the cervix, while identifying factors associated with recurrence, with a particular emphasis on the role of human papillomavirus (HPV) testing.

Methods: We retrospectively reviewed data from all patients with histopathologically confirmed adenocarcinoma in situ or microinvasive cervical adenocarcinoma who received treatment at a single center between 2002 and 2023. The study involved the examination of consecutive surgical specimens and the follow-up details. Factors associated with recurrence were assessed in a subgroup of patients with available long-term follow-up data (at least 6 months).

Results: In total, 143 patients (112 with adenocarcinoma in situ and 31 with adenocarcinoma) were included in the analysis. Among the 86 patients who underwent fertility-sparing treatment, the recurrence rate was 9% (12% for adenocarcinoma in situ and 4% for adenocarcinoma) during a median follow-up period of 56.6 months (range 7-179). No patients who were HPV negative experienced recurrence during the follow-up period. In contrast, among patients who were HPV positive, the recurrence rate was 38%. Additionally, HPV 16/18 positivity displayed a notable association with a higher risk of recurrence compared with the other high-risk genotypes, although this difference did not reach statistical significance (83% vs 10%; p=0.083, log-rank).

Conclusion: Our retrospective study demonstrated a significant association between the risk of recurrence and HPV status during the follow-up period. Consequently, long-term follow-up utilizing HPV testing and genotyping appears to be a secure alternative to a hysterectomy.

Keywords: Adenocarcinoma; Gynecologic Surgical Procedures; Uterine Cervical Neoplasms.