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HPV-Nachweis in der Nachsorge bei CIN

Eine systematische Übersichtsarbeit

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Zusammenfassung

Für diese systematische Übersichtsarbeit wurden alle Artikel der Datenbank "Pubmed" der US-amerikanischen National Library of Medicine analysiert, welche eine Aussage über die Persistenz von HPV nach Therapie einer zervikalen intraepithelialen Neoplasie (CIN) treffen. Bei den 18 analysierten Arbeiten wurde zudem die Studienqualität hinsichtlich ihres Evidenzgrades überprüft. Die Therapie der CIN führt meist zu einer HPV-Elimination und stellt somit ein kausales Therapieverfahren dar. Die besondere Bedeutung eines negativen HPV-Tests liegt in dem hohen negativen Vorhersagewert, da ein negativer Test CIN-Persistenz bzw. -Rezidiv mit hoher Wahrscheinlichkeit ausschließt. Dies gilt auch bei inkompletter Resektion (befallene Schnittränder). Die Sensitivität des HPV-Nachweises hinsichtlich einer persistierenden oder rezidivierenden CIN ist sehr hoch, eine Kombination mit der Zytologie führt zu noch höherer Sicherheit. Der HPV-Test hilft also, sowohl Über- als auch Untertherapie nach CIN-Therapie zu vermeiden. Die Schlussfolgerungen müssen jedoch aufgrund fehlender prospektiver randomisierter Studien als vorläufig betrachtet werden.

Abstract

This systematic review was done with the database Pubmed of the National Library of Medicine. All published papers that deal with HPV persistence after CIN therapy were analyzed. In addition, we tried to evaluate the quality of the studies with regard to the level of evidence. Altogether 18 studies could be included. HPV is usually eradicated after treatment of CIN indicating causal therapy. The negative predictive value of a negative HPV test is very high since a negative HPV test almost excludes CIN persistence or recurrence. This is also true after incomplete resection of CIN. Sensitivity of a HPV test with regard to detection of CIN recurrence is high. The combination of cytology and HPV testing increases the safety of follow-up after CIN therapy. HPV testing helps to avoid over- or undertreatment after CIN therapy. The conclusions, however, are preliminary because of missing prospective and controlled trials.

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Literatur

  1. Gunasekera PC, Phipps JH, Lewis BV (1990) Large loop excision of the transformation zone (LLETZ) compared to carbon dioxide laser in the treatment of CIN: a superior mode of treatment. Br J Obstet Gynaecol 97: 995–998

    Article  CAS  PubMed  Google Scholar 

  2. Benedet JL, Miller DM, Nickerson KG (1992) Results of conservative management of cervical intraepithelial neoplasia. Obstet Gynecol 79: 105–110

    CAS  PubMed  Google Scholar 

  3. Alvarez RD, Helm CW, Edwards RP et al. (1994) Prospective randomized trial of LLETZ vs. laser ablation in patients with cervical intraepithelial neoplasia. Gynecol Oncol 52: 175–179

    Article  CAS  PubMed  Google Scholar 

  4. Mitchell MF, Tortolero-Luna G, Cook E, Whittaker L, Rhodes-Morris H, Silva E (1998) A randomized clinical trial of cryotherapy, laser vaporization, and loop electrosurgical excision for treatment of squamous intraepithelial lesions of the cervix. Obstet Gynecol 92: 737–744

    Article  CAS  PubMed  Google Scholar 

  5. Hillemanns P, Kimmig R, Dannecker C et al. (2000) LEEP vs. cold knife conization for treatment of cervical intraepithelial neoplasias. Zentralbl Gynakol 122: 35–42

    CAS  PubMed  Google Scholar 

  6. Reich O, Lahousen M, Pickel H, Tamussino K, Winter R (2002) Cervical intraepithelial neoplasia III: long-term follow-up after cold-knife conization with involved margins. Obstet Gynecol 99: 193–196

    PubMed  Google Scholar 

  7. Soutter WP, de Barros Lopes A, Fletcher A et al. (1997) Invasive cervical cancer after conservative therapy for cervical intraepithelial neoplasia. Lancet 349: 978–980

    Article  CAS  PubMed  Google Scholar 

  8. Bigrigg A, Haffenden DK, Sheehan AL, Codling BW, Read MD (1994) Efficacy and safety of large-loop excision of the transformation zone. Lancet 343: 32–34

    Article  CAS  PubMed  Google Scholar 

  9. Bollen LJ, Tjong AHSP, van der Velden J et al. (1999) Prediction of recurrent and residual cervical dysplasia by human papillomavirus detection among patients with abnormal cytology. Gynecol Oncol 72: 199–201

    Article  CAS  PubMed  Google Scholar 

  10. Schneider A, Hoyer H, Lotz B et al. (2000) Screening for high-grade cervical intra-epithelial neoplasia and cancer by testing for high-risk HPV, routine cytology or colposcopy. Int J Cancer 89: 529–534

    Article  CAS  PubMed  Google Scholar 

  11. Elfgren K, Bistoletti P, Dillner L, Walboomers JM, Meijer CJ, Dillner J (1996) Conization for cervical intraepithelial neoplasia is followed by disappearance of human papillomavirus deoxyribonucleic acid and a decline in serum and cervical mucus antibodies against human papillomavirus antigens. Am J Obstet Gynecol 174: 937–942

    Article  CAS  PubMed  Google Scholar 

  12. Nobbenhuis MA, Walboomers JM, Helmerhorst TJ et al. (1999) Relation of human papillomavirus status to cervical lesions and consequences for cervical-cancer screening: a prospective study. Lancet 354: 20–25

    Article  CAS  PubMed  Google Scholar 

  13. Ho GY, Bierman R, Beardsley L, Chang CJ, Burk RD (1998) Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med 338: 423–428

    Article  CAS  PubMed  Google Scholar 

  14. Remmink AJ, Walboomers JM, Helmerhorst TJ et al. (1995) The presence of persistent high-risk HPV genotypes in dysplastic cervical lesions is associated with progressive disease: natural history up to 36 months. Int J Cancer 61: 306–311

    Article  CAS  PubMed  Google Scholar 

  15. Chua KL, Hjerpe A (1997) Human papillomavirus analysis as a prognostic marker following conization of the cervix uteri. Gynecol Oncol 66: 108–113

    Article  CAS  PubMed  Google Scholar 

  16. Cruickshank ME, Sharp L, Chambers G, Smart L, Murray G (2002) Persistent infection with human papillomavirus following the successful treatment of high grade cervical intraepithelial neoplasia. Br J Obstet Gynecol 109: 579–581

    Article  Google Scholar 

  17. Acladious NN, Sutton C, Mandal D, Hopkins R, Zaklama M, Kitchener H (2002) Persistent human papillomavirus infection and smoking increase risk of failure of treatment of cervical intraepithelial neoplasia (CIN). Int J Cancer 98: 435–439

    Article  CAS  PubMed  Google Scholar 

  18. Kjellberg L, Wadell G, Bergman F, Isaksson M, Angstrom T, Dillner J (2000) Regular disappearance of the human papillomavirus genome after conization of cervical dysplasia by carbon dioxide laser. Am J Obstet Gynecol 183: 1238–1242

    Article  CAS  PubMed  Google Scholar 

  19. Nobbenhuis MA, Meijer CJ, van den Brule AJ et al. (2001) Addition of high-risk HPV testing improves the current guidelines on follow-up after treatment for cervical intraepithelial neoplasia. Br J Cancer 84: 796–801

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Kucera E, Sliutz G, Czerwenka K, Breitenecker G, Leodolter S, Reinthaller A (2001) Is high-risk human papillomavirus infection associated with cervical intraepithelial neoplasia eliminated after conization by large-loop excision of the transformation zone? Eur J Obstet Gynecol Reprod Biol 100: 72–76

    Article  CAS  PubMed  Google Scholar 

  21. Elfgren K, Jacobs M, Walboomers JM, Meijer CJ, Dillner J (2002) Rate of human papillomavirus clearance after treatment of cervical intraepithelial neoplasia. Obstet Gynecol 100: 965–971

    PubMed  Google Scholar 

  22. Lin CT, Tseng CJ, Lai CH et al. (2001) Value of human papillomavirus deoxyribonucleic acid testing after conization in the prediction of residual disease in the subsequent hysterectomy specimen. Am J Obstet Gynecol 184: 940–945

    Article  CAS  PubMed  Google Scholar 

  23. Bekkers RL, Melchers WJ, Bakkers JM et al. (2002) The role of genotype-specific human papillomavirus detection in diagnosing residual cervical intraepithelial neoplasia. Int J Cancer 102: 148–151

    Article  CAS  PubMed  Google Scholar 

  24. Jain S, Tseng CJ, Horng SG, Soong YK, Pao CC (2001) Negative predictive value of human papillomavirus test following conization of the cervix uteri. Gynecol Oncol 82: 177–180

    Article  CAS  PubMed  Google Scholar 

  25. Nagai Y, Maehama T, Asato T, Kanazawa K (2000) Persistence of human papillomavirus infection after therapeutic conization for CIN 3: is it an alarm for disease recurrence? Gynecol Oncol 79: 294–299

    Article  CAS  PubMed  Google Scholar 

  26. Bollen LJ, Tjong AHSP, van der Velden J et al. (1996) Human papillomavirus DNA after treatment of cervical dysplasia: low prevalence in normal cytologic smears. Cancer 77: 2538–2543

    Article  CAS  PubMed  Google Scholar 

  27. Sesti F, De Santis L, Farne C, Mantenuto L, Piccione E (1994) Efficacy of CO2 laser surgery in treating squamous intraepithelial lesions. An analysis of clinical and virologic results. J Reprod Med 39: 441–444

    CAS  PubMed  Google Scholar 

  28. Bollen LJ, Tjong AHSP, van der Velden J et al. (1997) Clearance of cervical human papillomavirus infection by treatment for cervical dysplasia. Sex Transm Dis 24: 456–460

    Article  CAS  PubMed  Google Scholar 

  29. Distefano AL, Picconi MA, Alonio LV et al. (1998) Persistence of human papillomavirus DNA in cervical lesions after treatment with diathermic large loop excision. Infect Dis Obstet Gynecol 6: 214–219

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Kanamori Y, Kigawa J, Minagawa Y et al. (1998) Residual disease and presence of human papillomavirus after conization. Oncology 55: 517–520

    Article  CAS  PubMed  Google Scholar 

  31. Strand A, Wilander E, Zehbe I, Rylander E (1997) High risk HPV persists after treatment of genital papillomavirus infection but not after treatment of cervical intraepithelial neoplasia. Acta Obstet Gynecol Scand 76: 140–144

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Frauenheilkunde, Klinikum der Universität München-Großhadern, Germany

    C. Dannecker

  2. Klinik und Poliklinik für Frauenheilkunde, Klinikum der Universität München-Großhadern, Marchioninistraße 15, 81377 , München, Germany

    C. Dannecker, P. Hillemanns & H. Hepp

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  1. C. Dannecker
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  2. P. Hillemanns
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  3. H. Hepp
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Correspondence to C. Dannecker.

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Dannecker, C., Hillemanns, P. & Hepp, H. HPV-Nachweis in der Nachsorge bei CIN. Gynäkologe 36, 331–340 (2003). https://doi.org/10.1007/s00129-003-1341-6

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