Prediction of residual/recurrent disease by HPV Genotype after loop excision procedure for high-grade cervical intraepithelial neoplasia with negative margins

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Abstract
This study aims to evaluate whether the preconisation of high-risk human papillomavirus (HR-HPV) genotype and multiple HPV infection is predictive for residual/recurrent disease during the follow-up of high-grade cervical intraepithelial neoplasia (CIN) treated by loop electrosurgical excision procedure (LEEP) with negative margins. Two hundred and thirty-six women (mean age 37; range 20-61) with CIN2/3 treated by LEEP conisation with negative margins confirmed by pathology examination of the surgical specimen were included. The cervical cells for HPV genotype testing by the polymerase chain reaction (PCR) were collected before, and 6, 12, 24 months after treatment, respectively. HPV genotype and multiple HPV infection were evaluated as possible predictors of residual/recurrent disease. Residual/recurrent disease was demonstrated by colposcopy-guided biopsy in 62 patients (26.3%) who underwent loop conisation with negative margins. Preoperative infection with either HPV16 (P = 0.007), HPV18 (P = 0.000), HPV33 (P = 0.001) or HPV45 (P = 0.019) was associated with higher rates of residual/recurrent lesions after conisation with negative margins. Preoperative infection with multiple HPV types was associated with the highest rate of residual/recurrent lesions compared with infection with single HPV type and HPV-negative cases (χ2 = 16.599, P < 0.001). Results demonstrate that the presence of HPV-16, 18, 33 and 45, as well as multiple HPV types pre-LEEP, is associated with higher rates of residual/recurrent disease after LEEP.

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