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01-07-2011 | Gynecologic Oncology

Factors associated with recurrence of cervical intraepithelial neoplasia after conization in HIV-infected and noninfected women

Authors: Claudia Teixeira Lodi, Márcia Antoniazi Michelin, Maria Inês Lima, Nara Chartuni Teixeira, Sheila Jorge Adad, Eddie Fernando Murta, Victor Hugo Melo

Published in: Archives of Gynecology and Obstetrics | Issue 1/2011

Abstract

Purpose

To identify risk factors associated with recurrence of cervical intraepithelial neoplasia (CIN) following loop electrosurgical excision procedures in women with and without human immunodeficiency virus (HIV).

Methods

A total of 33 patients with recurrent CIN and 105 without recurrence were contrasted using a nested case–control design. The patients were enrolled between 1999 and 2004. Recurrence diagnosis was established after conization, and tissues were fixed in formalin and embedded in paraffin. Polymerase chain reaction was used to detect the human papillomavirus genome (HPV DNA) types 6, 11, 16, 18, 31, 33, and 35. Statistical analysis was performed using χ² test with Yates correction and the Fisher’s exact test for comparison of categorical variables. Multivariate analysis was carried out using logistic regression models.

Results

Human immunodeficiency virus infection (p = 0.001), glandular involvement (p = 0.000), and compromised margins (p = 0.02) were significantly associated with CIN recurrence. HPV DNA was positive in 57.6% of patients with CIN recurrence. High-risk HPV subtypes were detected in most cases but were not associated with recurrence (p = 0.27). In multivariate analysis, HIV infection and glandular involvement were independently associated with CIN recurrence.

Conclusions

Human immunodeficiency virus infection and glandular involvement are associated with CIN recurrence.

Zur Hausen H (2000) Papillomaviruses causing cancer: evasion from host cell control in early events in carcinogenesis. J Natl Cancer Inst 92:690–698PubMedCrossRef

Bae JH, Kim CJ, Park TC, Namkoong SE, Park JS (2007) Persistence of human papillomavirus as a predictor for treatment failure after loop electrosurgical excision procedure. Int J Gynecol Cancer 17:1271–1277PubMedCrossRef

Aerssens A, Claeys P, Garcia A, Sturtewagen Y, Velasquez R, Vanden Broeck D et al (2008) Natural history and clearance of HPV after treatment of precancerous cervical lesions. Histopathology 52:381–386PubMedCrossRef

Sarian LO, Derchain SF, Pittal Dda R, Morais SS, Rabelo-Santos SH (2004) Factors associated with HPV persistence after treatment for high-grade cervical intra-epithelial neoplasia with large loop excision of the transformation zone (LLETZ). J Clin Virol 31:270–274PubMedCrossRef

Lima MIM, Tafuri A, Araújo AC, Lima LM, Melo VH (2009) Cervical intraepithelial neoplasia recurrence after conization in HIV-positive and HIV-negative women. Int J Gynecol Obstet 104:100–104CrossRef

Alonso I, Torné A, Puig-Tintoré LM, Esteve R, Quinto L, Campo E et al (2006) Pre and post-conization high-risk HPV testing predicts residual/recurrent disease in patients treated for CIN 2–3. Gynecol Oncol 103:631–636PubMedCrossRef

Fogle RH, Spann CO, Easley KA, Basil JB (2004) Predictors of cervical dysplasia after the loop electrosurgical excision procedure in an inner-city population. J Reprod Med 49(6):481–486PubMed

Heard I, Potard V, Foulot H, Chapron C, Costagliola D, Kazatchkine MD (2005) High rate of recurrence of cervical intraepithelial neoplasia after surgery in HIV-positive women. J Acquir Immune Defic Syndr 39(4):412–418PubMedCrossRef

Prato B, Ghelardi A, Gadducci A, Marchetti I, Di Cristofano C, Di Coscio G et al (2008) Correlation of recurrence rates and times with posttreatment human papillomavirus status in patients treated with loop electrosurgical excision procedure conization for cervical squamous intraepithelial lesions. Int J Gynecol Cancer 18:90–94PubMedCrossRef

10.

Park JY, Kim DY, Kim JH, Kim YM, Kim YT, Nam JY (2009) Human Papillomavirus Test after Conization in Predicting Residual Disease in Subsequent Hysterectomy Specimens. Obstet Gynecol 114(1):87–92PubMed

11.

Zaitoun AM, Mckee G, Coppen MJ, Thomas SM, Wilson POG (2000) Completeness of excision and follow-up cytology in patients treated with loop excision biopsy. J Clin Pathol 53:191–196PubMedCrossRef

12.

Johnson N, Khalili M, Hirschowitz L, Ralli F, Porter R (2003) Predicting residual disease after excision of cervical dysplasia. Br J Obstet Gynaecol 110:952–955CrossRef

13.

Verguts J, Bronselaer B, Donders G, Arbyn M, Van Eldere J, Drijkoningen M, Poppe W (2006) Prediction of recurrence after treatment for high-grade cervical intraepithelial neoplasia: the role of human papillomavirus testing and age at conization. Int J Obstet Gynaecol 113:1303–1307

14.

Skinner EN, Gehrig PA, Van Le L (2004) High-grade squamous intra-epithelial lesions: abbreviating posttreatment surveillance. Obstet Gynecol 103:488–492PubMedCrossRef

15.

Pinto AP, Crum CP (2000) Natural history of cervical neoplasia: defining progression and its consequence. Clin Obstet Gynecol 43:352–362PubMedCrossRef

16.

Munoz N, Bosch X, Sanjosé S, Herrero R, Castellsagué X, Shah KV et al (2003) Epidemiologic Classification of human papillomavirus types associated with cervical cancer. N Engl J Med 348:518–527PubMedCrossRef

17.

Gilles C, Manigart Y, Konopnicki D, Barlow P, Rozenberg S (2005) Management and outcome of cervical intraepithelial neoplasia lesions: a study of matched cases according to HIV status. Gynecol Oncol 96:112–118PubMedCrossRef

18.

Nappi L, Carriero C, Bettocchi S, Herrero J, Vimercati A, Putignano G (2005) Cervical squamous intraepithelial lesions of low-grade in HIV-infected women: recurrence, persistence and progression, in treated and untreated women. Eur J Obstet Gynecol Reprod Biol 121:226–232PubMedCrossRef

19.

Walker P, Dexeus S, de Palo G, Barrasso R, Campion M, Girardi F et al (2009) International terminology of colposcopy: an updated report from the international federation for cervical pathology and colposcopy. Available at: http://www.ifcpc.org/ifcpc/terminology.htm. Accessed: 12 Sep 2009

20.

Smith JH (2002) Bethesda 2001. Cytopathology 13(1):4–10PubMedCrossRef

21.

Paraskevaidis E, Kalantaridou SN, Paschopoulos M, Zikopoulos K, Diakomanolis E, Dalkalitsis N et al (2003) Factors affecting outcome after incomplete excision of cervical intraepithelial neoplasia. Eur J Gynaecol Oncol 24(6):541–543PubMed

22.

Costa S, De Simone P, Venturoli S, Cricca M, Zerbini ML, Musiani M et al (2003) Factors predicting human papillomavirus clearance in cervical intraepithelial neoplasia lesions treated by conization. Gynecol Oncol 90:358–365PubMedCrossRef

23.

Melnikow J, McGahan C, Sawaya GF, Ehlen T, Coldman A (2009) Cervical intraepithelial neoplasia outcomes after treatment: long-term follow-up from the british columbia cohort study. J Natl Cancer Inst 101:721–728PubMedCrossRef

24.

Maluf PJ, Michelin MA, Etchebehere RM, Adad SJ, Murta ECT (2008) Lymphocytes (CD3) may participate in the recurrence of cervical intraepithelial neoplasia grade III. Arch Gynecol Obstet 278:525–530PubMedCrossRef

25.

Nonogaki S, Wakamatsu A, Longatto Filho A, Pereira SMM, Utagawa ML, Alves VAF et al (2004) Hybrid Capture II and polymerase chain reaction for identifying HPV infections in samples collected in a new collection medium. Acta Cytol 48:514–520PubMedCrossRef

Title: Factors associated with recurrence of cervical intraepithelial neoplasia after conization in HIV-infected and noninfected women
Authors: Claudia Teixeira Lodi
Márcia Antoniazi Michelin
Maria Inês Lima
Nara Chartuni Teixeira
Sheila Jorge Adad
Eddie Fernando Murta
Victor Hugo Melo
Publication date: 01-07-2011
Publisher: Springer-Verlag
Published in: Archives of Gynecology and Obstetrics / Issue 1/2011
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-010-1611-1

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Factors associated with recurrence of cervical intraepithelial neoplasia after conization in HIV-infected and noninfected women

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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