Human papillomavirus genotyping as a reliable prognostic marker of recurrence after loop electrosurgical excision procedure for high-grade cervical intraepithelial neoplasia (CIN2-3) especially in postmenopausal women.

OBJECTIVE: This study was conducted to determine, using the HPV DNA Chip (HDC) test, whether the human papillomavirus (HPV) genotype is predictive of recurrent high-grade cervical intraepithelial neoplasia (CIN; CIN2-3) after a loop electrosurgical excision procedure (LEEP) in postmenopausal women.
METHODS: Between January 2007 and February 2013, 206 postmenopausal women with CIN2-3 were treated with LEEP, followed by cytology, Hybrid Capture II (HC2) assay, and HDC test. Post-LEEP follow-up was performed at 3, 6, 9, 12, 18, and 24 months during the first 2 years and yearly thereafter.
RESULTS: Among 206 women, HC2 yielded positive results in 199 women (96.6%) and HDC yielded positive results in 201 women (97.6%) before LEEP. The overall agreement between HDC and HC2 was 99.0%. The area under the receiver operating characteristic curve for high-risk HPV (HR-HPV) viral load measured by HC2 predicting recurrent CIN2-3 was 0.567 (P = 0.335). Twenty-six women (12.6%) developed recurrence, and those who developed recurrence tested positive for the same HR-HPV genotype before and after LEEP. The same HR-HPV genotype by HDC during follow-up had a sensitivity and negative predictive value of 100% in detecting recurrent disease. HPV-18 was significantly associated with recurrent CIN2-3 (P < 0.05).
CONCLUSIONS: Among postmenopausal women, persistent infection with the same HR-HPV genotype, especially HPV-18, should be considered a risk factor for developing recurrent CIN2-3. After LEEP, such women warrant special attention with intense follow-up.