Application of HPV DNA Testing in Follow-up after Loop Electrosurgical Excision Procedures in Northern Thailand


Background: HPV DNA testing has been recently introduced as an adjunct test to cytology in the follow-up ofpatients after treatment for cervical lesions using the loop electrosurgical excision procedure (LEEP). The aim ofthis study was to evaluate the role of HPV testing in the detection of persistent or recurrent disease after LEEP inpatients with cervical epithelial lesions in northern Thailand. Materials and
Methods: Patients who underwentLEEP as a treatment for histological low-grade (LSIL) or high-grade squamous intraepithelial lesion (HSIL)or worse at Chiang Mai University Hospital between June 2010 and May 2012 were included. Follow-ups werescheduled at 6-month intervals and continued for 2 years using co-testing (liquid-based cytology and HybridCapture 2 [HC2]) at 6 months and 24 months and liquid-based cytology alone at 12 and 18 months.
Results: Of98 patients included, the histological diagnoses for LEEP included LSIL in 16 patients, and HSIL or worse in82 patients. The LEEP margin status was negative in 84 patients (85.7%). At follow-up, 10 patients (10.2%) hadpersistent/recurrent lesions; 4 among LSIL patients (25.0%) and 6 in the group with HSIL or worse (7.3%). Only2 of 82 patients (2.4%) with HSIL or worse diagnoses had histological HSIL in the persistent/recurrent lesions.Using histologically confirmed LSIL as the threshold for the detection of persistent/recurrent disease, cytology hada higher sensitivity than HC2 (90.0% versus 70.0%). At the 6-month follow-up appointment, combined cytologyand HC2 (co-testing) had a higher sensitivity in predicting persistent/recurrent disease (80.0%) compared withthat of cytology alone (70.0%) and HC2 (50.0%).
Conclusions: After LEEP with a negative surgical margin, therate of persistent/recurrent lesions is low. The addition of HPV testing at the 6-month visit to the usual cytologyschedule may be an effective approach in the follow-up after LEEP.