High-risk human papillomavirus E6/E7 mRNA and L1 DNA as markers of residual/recurrent cervical intraepithelial neoplasia

The aim of this study was to assess the use of human papillomavirus (HPV)E6/E7 mRNA testing in the follow-up of women treated for cervical intraepithelialneoplasia (CIN) by conization and to compare the prognostic value of HPV E6/E7mRNA to HPV L1 DNA and cytology. One hundred and forty-three women underwent cytological/histologicaltesting, HPV DNA genotyping by Linear Array, and HPV E6/E7 mRNA testing by APTIMAHPV assay during follow-up after surgical treatment for histologically verifiedCIN. High-grade residual/recurrent disease (CIN2+/HSIL+) was identified in 7 (4.9%)women, and low-grade disease (CIN1/LSIL) in 25 (17.5%). At the inclusion visit33 (23%) women were HPV DNA-positive; 13 (9.0%) were HPV E6/E7 mRNA-positive.HPV E6/E7 mRNA did not identify three women with high-grade disease. Presenceof high-risk HPV DNA at the inclusion visit predicted 100% (95% CI 64.6-100) ofhigh-grade residual/recurrent disease, with a specificity of 80.9% (95% CI 73.5-86.6);cytology had a sensitivity of 85.7%, and a specificity of 87.5%. HPV E6/E7 mRNAtesting was a poor predictor of treatment failure, with a sensitivity of 57.1%(95% CI 25.0-84.2), but high specificity (93.4%; 95% CI 87.9-96.5). Detectionof high-risk HPV DNA after treatment by conization identified 100% of women withresidual/recurrent high-grade disease, whereas HPV E6/E7 mRNA testing was a poorpredictor of treatment failure. This study suggests that a negative HPV mRNA resultcannot exclude the risk of malignant progression, and that HPV E6/E7 mRNA testingby APTIMA HPV assay is not useful in the follow-up of women treated for CIN.