Value of endocervical margin and high-risk human papillomavirus status after conization for high-grade cervical intraepithelial neoplasia, adenocarcinoma in situ, and microinvasive carcinoma of the uterine cervix

- Post-cone HR-HPV positivity, not a high pre-cone HR-HPV viral load, is a significant predictor of residual/recurrent disease.
- The patients with positive endocervical margin show the post-cone HR-HPV positivity as well as the residual/recurrent disease.
- Most patients with positive HR-HPV status of ASCUS and LSIL are converted to negative status.

ObjectiveThe aim of this study was to analyze clinico-pathologic factors and the optimal cut-off value of high-risk human papillomavirus (HR-HPV) viral load for predicting high-grade residual/recurrent disease after the conization in cervical intraepithelial neoplasia (CIN 2-3), adenocarcinoma in situ (AIS), and microinvasive carcinoma of the uterine cervix (MICA).MethodsWe retrospectively reviewed data from 701 patients with CIN 2-3, AIS, and MICA who underwent conization between September 2003 and June 2012. Receiver-operating characteristic curve analysis was used to find out the cut-off value of HR-HPV viral load for predicting residual/recurrent disease. Clinico-pathologic variables, including resection margin and HR-HPV status, were evaluated as possible predictors of residual/recurrent disease.ResultsAt a cut-off value of 1.16 RLU/CO for post-cone HR-HPV viral load, the sensitivity was 88.2% and the specificity was 98.3%. Multivariate analysis demonstrated that post-cone cytology (p = 0.001, OR = 83.808, 95% CI = 6.688-1050.232), endocervical margin status (p < 0.001, OR = 80.478, 95% CI = 7.421-872.732), and post-cone HR-HPV status (p < 0.001, OR = 79.660, 95% CI = 8.539-743.129) were significantly associated with residual/recurrent disease. The post-cone HR-HPV positivity was observed more in the patients who showed positive endocervical margin than in the patients with positive ectocervical margin (32.6% vs. 5.3%, p = 0.002).ConclusionsFollow-up using liquid based cytology in combination with HR-HPV test at 12 months after the conization, and not the early HR-HPV test, might be acceptable. Post-cone endocervical margin status combined with post-cone HR-HPV test is critical for predicting residual/recurrent disease and clinical management.