Human papillomavirus (HPV) test and PAP smear as predictors of outcome in conservatively treated adenocarcinoma in situ (AIS) of the uterine cervix

Silvano Costa, Giovanni Negri, Mario Sideri, Donatella Santini, Giuseppe Martinelli, Simona Venturoli, Carla Pelusi, Stina Syrjanen, Kari Syrjanen, Giuseppe Pelusi

Research output: Contribution to journalArticle

Abstract

Objective: The present study assessed (i) the clinical outcome of patients with conservatively treated cervical adenocarcinoma in situ (AIS), (ii) the accuracy of diagnosing AIS by cytology, colposcopy and histology, as well as (iii) the performance of cervical cytology and HPV testing in detection of residual or recurrent disease after conservatively treated AIS. Methods: A series of 42 consecutive women (mean age 40.5 years; range 27-63 years) underwent conservative (cone) treatment of AIS and were prospectively followed up for a mean of 40 months (median 42 months), using colposcopy, PAP smear, biopsy and HPV testing (with hybrid capture II) repeated at 6-month intervals. Results: In their referral PAP test, only 42.9% of patients had atypical glandular cells (AGC) smear. Colposcopy was unsatisfactory in 54.8% cases and negative in 16.7%. Twenty four patients (57.1%) had AIS as a pure lesions and 18 combined with squamous cell lesion (four had invasive SCC). Persistent or recurrent disease was observed in 17 (40.4%) cases, 19% in patients with free margins, and 65% among those with involved margins on the first conization. In four patients, an adenocarcinoma (AdCa) stage IA1 was diagnosed during the follow-up. HPV testing significantly predicted disease persistence/clearance with OR 12.6 (95% CI 1.18-133.89), while the predictive power of PAP smear did not reach statistical significance at any of the follow-up visits. The combination of PAP smear and HPV testing gives SE of 90.0%, SP 50.0%, PPV 52.9% and NPV 88.9% at first follow-up, and 100% SE and 100% NPV at the second follow-up visit. Conclusions: These results suggest that HR-HPV test in conjunction with cytology offers clear advantages over single cytology in monitoring the women conservatively treated for cervical AIS.

Original languageEnglish
Pages (from-to)170-176
Number of pages7
JournalGynecologic Oncology
Volume106
Issue number1
DOIs
Publication statusPublished - Jul 2007

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Keywords

  • Adenocarcinoma in situ
  • Conservative treatment
  • Follow-up
  • HPV testing
  • Outcome
  • PAP smear
  • Prospective
  • Test performance
  • Uterine cervix

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Oncology

Cite this

Costa, S., Negri, G., Sideri, M., Santini, D., Martinelli, G., Venturoli, S., Pelusi, C., Syrjanen, S., Syrjanen, K., & Pelusi, G. (2007). Human papillomavirus (HPV) test and PAP smear as predictors of outcome in conservatively treated adenocarcinoma in situ (AIS) of the uterine cervix. Gynecologic Oncology, 106(1), 170-176. https://doi.org/10.1016/j.ygyno.2007.03.016