RISK FACTORS ASSOCIATED WITH PERSISTENCE, RECURRENCE AND PROGRESSION OF CERVICAL INTRAEPITHELIAL NEOPLASIA (CIN) AFTER COLD KNIFE CONIZATION

Year 2013, Volume: 16 Issue: 2, 44 - 48, 01.04.2013

Dimitrov Go Dimitrov Gl Dzikova E Panov S Ceselkovska M Babusku Gj

Abstract

Objective: The aim of this study was to evaluate the significant
risk factors that influence on persistence, recurrence and progression
of CIN after cold-knife conization (CKC)
Design: Prospective follow-up study.
Methods: We retrospectively analyzed the likelihood of recurrent/residual
disease in 143 pa-tients (mean age 39, 3 years, range 22
to 58 years) who underwent cold knife conization for CIN at the
General Hospital Remedika, Department for Gynecology and
Obstetrics, Skopje, Mace-donia in a period of 5 years.
Results: Women with HR- HPV DNA after cold knife conization
had a 17,5 % risk of reccur-ence, whereas 0,8% of women with absent
HR – HPV DNA were with recurrent/persistent CIN.
Conclusion: Persistence of HR-HPV DNA was only significant
risk factor for recurrence and progression of cervical intraepithelial
neoplasia (CIN) after Cold Knife Conization. Women with post-treatment
HR-HPV types should be carefully followed-up every 4 months
in a period of 2 years and all cytology abnormalities, followed by histological
verification should be appropriately treated. Long-term follow-up
strategy is obligatory because HR-HPV infection plays a predominant
role in the pathogenesis of pre-invasive and invasive cervical
cancer.

Keywords

Cold Knife Conization, CIN, HR- HPV Infection, Persistence, Recurrence.

References

• 1. GLOBOCAN 2008 (IARC), International Agency for Research on Cancer, Section of Cancer Information, 2012
• 2. WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre). Human Papillomavirus and Related Cancers in World. Summary Report 2010. [Date accessed 24/10/2012]. Available at www.who.int/hpvcentre
• 3. Munoz N, Castellsaque X, de Gonzalez A, Giessmann L. Chapter 1: HPV in the etiology of human cancer. Vaccine. 2006, 24, 1-10.
• 4. Bjerre B, Eliasson G, Linell F, et al. Conization as only treatment of carcinoma in situ of the uterine cervix.Am J Obstet Gynecol. May 15 1976; 125(2):143-52.
• 4. Burghardt E. Die diagnostische Konisation der Portio Vaginalis Uteri. Geburtshilfe, Frauenheilunde. 1963; 23:1.
• 5. Nagai Y, Maehama T, Asato T, Kanazawa K. Persistence of human papillomavirus infection after therapeutic conization for CIN 3: is it an alarm for disease recurrence? Gynecol. Oncol. 2000 Nov;79 (2):294–9.
• 6. Miller S.A., Dykes D.D., Polesky H.F. (1988): A simple salting out procedure for extracting DNA from human nucleatedcells. Nucleic Acids Research16:1215.
• 7. 2001 Consensus Guidelines for the management of women with cervical cytological abnormalities. Wright TC Jr, Cox JT, Massad LS, Twiggs LB, Wilkinson EJ, ASCCP-Sponsored Consensus Conference.JAMA. 2002 Apr 24; 287(16):2120-9.
• 8. Lin CT., Tseng CJ., Lai CH, Hsueh S., Huang KG., Huanhg HJ., et al., Value of human papillomavirus deoxyribonucleic acid testing after conization in the prediction of residual disease in the subsequent hysterectomy specimen, Am J Obstet Gynecol 2001, 184, 940-5.
• 9. Verguts J., Bronselaer B., Donders G., Arbyn M., Van Eldere J., Drijkoningen M., Poppe W., Prediction of recurence after treatment for high-grade cervical intraepithelial neoplasia: the role of human papillomavirus testing and age at conization, BJOG An international Journal of Obstetrics and Gynaecology, 2006, pp 1303-1307.
• 10. Zielinski GD, Bais AG, Helmerhorst TJ, Verheijen RH, de Schipper FA, Snijders PJ, Voorhorst FJ, van Kemenade FJ, Rozendaal L, Meijer CJ. HPV testing and monitoring of women after treatment of CIN 3: review of the literature and meta-analysis. Obstet Gynecol Surv. 2004 Jul;59(7):543-53
• 12. Wu D, Zheng Y, Chen W, Guo C, Yu J, Chen G, Huang Y. Prediction of residual/recurrent disease by HPV genotype after loop excision procedure for high-grade cervical intraepithelial neoplasia with negative margins Aust N Z J Obstet Gynaecol. 2011 Apr;51(2):114-8