Role of human papillomavirus testing and cytology in follow-up after conization

Camilla F Gosvig, Lene D Huusom, Isabelle Deltour, Klaus K Andersen, Anne Katrine Duun-Henriksen, Ellen Merete Madsen, Lone K Petersen, Lisbeth Elving, Lars Schouenbourg, Angelika Iftner, Edith Svare, Thomas Iftner, Susanne K Kjaer*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review


OBJECTIVE: Adequate follow-up of women who have undergone conization for high-grade cervical lesions is crucial in cervical cancer screening programs. We evaluated the performance of testing for high-risk human papillomavirus (HPV) types, cytology alone, and combined testing in predicting cervical intraepithelial neoplasia grade 2 or worse (CIN2+) after conization.

DESIGN: Prospective cohort study.

SETTING: Denmark.

POPULATION: 667 women attending for conization.

METHODS: Cervical specimens were collected during 2002-2006 at first visit after conization for cytological examination and Hybrid Capture 2 detection of high-risk HPV. The women were passively followed until 2 years after first follow-up visit by linkage to the nationwide Pathology Data Bank.

RESULTS: At first visit after conization (median time, 3.4 months), 20.4% were HPV-positive and 17.2% had atypical squamous intraepithelial lesions or more severe cytology (ASCUS+). The 2-year incidence of CIN2+ after conization was 3.6%. Sensitivity for detection of CIN2+ after conization was 81.0% [95% confidence interval (CI) 58.1-94.6] for positive cytology (ASCUS+ threshold) and 95.2% (95% CI 76.2-99.9) for HPV testing and for combined testing. Specificity of ASCUS+ cytology (85.2%; 95% CI 82.0-88.0) was higher than that of HPV testing (82.4%; 95% CI 79.0-85.4) and markedly higher than that of combined testing (73.2%; 95% CI 69.3-76.8). The margin status had no significant added value.

CONCLUSIONS: Testing for high-risk HPV three to four months after conization is more sensitive than ASCUS+ cytology for identifying women at risk for relapse of CIN2+ within 2 years. Further studies are needed to evaluate whether HPV testing could be a stand-alone test in follow up after conization.

Original languageEnglish
JournalActa Obstetricia et Gynecologica Scandinavica
Issue number4
Pages (from-to)405-411
Publication statusPublished - Apr 2015
Externally publishedYes


  • Adult
  • Cervical Intraepithelial Neoplasia/pathology
  • Conization
  • Early Detection of Cancer/methods
  • Female
  • Follow-Up Studies
  • Humans
  • Neoplasm Recurrence, Local/diagnosis
  • Papillomavirus Infections/complications
  • Prospective Studies
  • Sensitivity and Specificity
  • Uterine Cervical Neoplasms/pathology
  • Vaginal Smears
  • relapse
  • Cervix
  • HPV
  • specificity
  • sensitivity
  • conization


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