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Predictive Value of 6-Month Cotest Results for Recurrence After Cervical Excision in Cervical Intraepithelial Neoplasia: A Single-Center Experience
Atacem Mert Aytekin1, Doğu Küçüksüleymanoğlu2, ŞEYMA OKUMUŞ AYTEKİN2, ELİF İBRAHİMAĞAOĞLU ORUÇ2, Ayşe YAVUZ1, BİLGEHAN SAĞLIK GÖKMEN1, Abdullah Serdar Açıkgöz1, Oguzhan Kuru1, Tugan bese11Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Istanbul,Türkiye2Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Istanbul,Türkiye
INTRODUCTION: Post-treatment surveillance is critical for the early detection of residual or recurrent disease in patients treated for cervical intraepithelial neoplasia grade 2–3 (CIN 2–3). While histopathological factors have traditionally been used to estimate recurrence risk, increasing evidence suggests that early postoperative human papillomavirus (HPV) testing may provide superior prognostic value.
METHODS: This retrospective observational cohort study included patients who underwent cervical excisional procedures for CIN 2–3 between January 2016 and May 2025 at a tertiary gynecologic oncology center. Patients with previous cervical excision or hysterectomy for cervical dysplasia were excluded. Cervical cytology and HPV test results obtained at the 6-month postoperative follow-up were recorded. Cytology was categorized as negative or abnormal (ASC-US or higher), and HPV results as positive or negative. Recurrence was defined as histopathologically confirmed CIN 2 or higher detected after the 6-month follow-up.
RESULTS: A total of 789 patients were analyzed. At 6 months, abnormal cytology was significantly more frequent in patients who developed recurrence (p < 0.001). Notably, none of the patients with recurrence were HPV negative, whereas HPV negativity was observed in 86.0% of patients without recurrence (p < 0.001). Persistent HPV positivity showed a moderate positive correlation with recurrence (r = 0.571, p < 0.01).
DISCUSSION AND CONCLUSION: Six-month postoperative cotesting is strongly associated with recurrence after cervical excisional treatment for CIN 2–3. Persistent HPV positivity represents the most powerful predictor of recurrence, while cytology provides additional risk stratification when evaluated alongside HPV testing. These findings support the clinical value of early HPV-based follow-up strategies.
Keywords: Cervical intraepithelial neoplasia, HPV persistence, cotesting,, Post-excisional follow-up
Manuscript Language: English