HPV-test verbetert follow-up na behandeling cervicaal intra-epitheliaal neoplasma*

Objective

To determine whether the addition of high-risk human papillomavirus (hrHPV) testing to cervical cytology improves diagnosis of residual or recurrent cervical intraepithelial neoplasia (CIN) in women who are being monitored after treatment for high-grade CIN (CIN2/3).

Design

Randomised clinical trial (the Dutch Cochrane Centre, registration number ISRCTN31244687).

Method

Women undergoing treatment of high-grade CIN (n = 210) were randomised to two groups, A and B. Cervical cytology was performed in women in group A 6, 12 and 24 months after treatment to detect residual or recurrent CIN. In group B this was combined with a hrHPV test. If the cytology was abnormal (group A) or the cyology was abnormal and the hrHPV test was positive (group B), colposcopic examintion was performed.

Results

The specificity of cervical cytology alone in the detection of residual or recurrent CIN was lower than that of cytology plus hrHPV test (80% versus 91%; relative risk: 0.87; 95% CI 0.77-0.99). The sensitivity did not differ between groups. If at the 6-month checkup cytology was normal and hrHPV was not present, the 12-month checkup could be omitted (specificity: 95%). This version of the follow-up protocol saved €59 per treated woman in unnecessary diagnostics.

Conclusion

The combination of cervical cytology and hrHPV test can improve follow-up after treatment of high-risk CIN. Women at low risk can be limited to a checkup 6 and 24 months after treatment. This reduces costs.