Vrijednost genotipizacije humanoga papiloma virusa u praćenju bolesnica s premalignim promjenama i početnim karcinomom vrata maternice nakon liječenja konizacijom [The value of HPV-HR DNA testing during the follow-up after the treatment of preinvasive disease of cervix uteri]

Banović, Maja (2016) Vrijednost genotipizacije humanoga papiloma virusa u praćenju bolesnica s premalignim promjenama i početnim karcinomom vrata maternice nakon liječenja konizacijom [The value of HPV-HR DNA testing during the follow-up after the treatment of preinvasive disease of cervix uteri]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Aims: We performed this study in order to improve diagnostic accuracy of the follow-up protocol after a treatment for preinvasive cervical disease, at the same time reducing the number of overtreated patients. Patients and methods: One hundred and fourteen patients were followed up after conization for CIN3 and/or AIS at 3-6 month, 9-12 month and 18-24 month intervals, then yearly. The follow-up consisted of cytology, colposcopy with biopsy if needed and HPV testing. The endpoint of the study was a secondary treatment due to a high suspicion of resdidual/recurrent disease or disease free period of at least 24 months. Results: The median follow-up time was 41 months (5-72 months). In predicting residual/recurrent disease cytology had a specificity of 88.9%, sensitivity of 100%, PPV of 33.3% and a NPV of 100% whereas HPV had a specificity of 76.9%, sensitivity of 100%, PPV of 21.4% and a NPV of 100%. Conclusion: According to our results both tests can be used as a primary follow-up tool after conization. The choice should depend on a socio-economic aspect. In our setting the HPV test should be done only in those patients with a positive smear any time during follow-up as the point of decision for a second treatment. With this approach we could considerably decrease the number of reoperated patients and co-morbidities.

Abstract in Croatian

Cilj: Poboljšati učinkovitost protokola praćenja bolesnica nakon konizacije zbog preinvazivne bolesti na vratu maternice, uz smanjenje broja reoperiranih bolesnica definirajući vrijednost i vremenski period ponavljanja citološke pretrage i HPV DNK testa. Ispitanice i metode: U istraživanju je sudjelovalo 114 bolesnica koniziranih zbog CIN3 i/ili AIS-a. Kontrolni nalazi su grupirani u tri skupine intervala praćenja: prvi (3-6 mjeseci), drugi (9-12 mjeseci) i treći (18-24 mjeseca). Uzet je uzorak za tekuću citološku analizu (engl. liquid-based cytology, LBC) i iz tog biološkog materijala određivana je prisutnost DNK visokorizičnog HPV-a. U slučaju pozitivnog testa određivan je zatim HPV genotip. Bolesnice su praćene barem 24 mjeseca od primarnog operacijskog zahvata (konizacija) ukoliko nije postavljena sumnja na rezidualnu bolest/recidiv ili do sekundarnog operacijskog zahvata. Rezultati: Medijan praćenja bolesnica je bio 41 mmjesec (5-72 mjeseca). Specifičnost citološkog nalaza za procjenu rezidualne bolesti/recidiva bila je 88,9%, osjetljivost 100%, PPV 33,3%, a NPV 100%. Specifičnost HPV testa je bila 76,9%, osjetljivost 100%, PPV 21,4%, NPV 100%. Zaključak: Prema našim rezultatima i citološki nalaz i HPV test mogu biti primarni testovi u praćenju bolesnica nakon konizacije. U našim okvirima HPV test je potrebno učiniti samo kod bolesnica s pozitivnim citološkim nalazom bilo kad nakon konizacije prije odluke o potrebnom ponovnom kirurškom zahvatu.

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