The role of HPV testing in the follow-up of patients in different clinical scenarios after diagnosis of cervical preinvasive lesions and carcinomas
Persistent human papillomavirus (HPV) infection is the causative factor for nearly all high-grade cervical lesions (CIN2/3) and invasive cervical cancers. HPV testing therefore plays a key role in the follow-up of patients treated surgically or managed conservatively. To optimize HPV testing in follow-up, we identified key clinical scenarios - conservative management of high-grade lesions, surveillance after conization or hysterectomy, post-surgical follow-up of cervical carcinoma, and monitoring after primary radiation therapy. We reviewed the evidence to propose a strategy for integrating HPV testing into follow-up. HPV testing shows high sensitivity and nearly 100% negative predictive value after conization for cervical high-grade lesions. Post-surgical HPV status is a more reliable predictor of recurrence than histopathological margin assessment. A negative result identifies patients with very low relapse risk. However, the lifetime risk of recurrent dysplasia remains increased and mainly depends on HPV status. Conversely, after fertility-sparing surgery for T1b cervical cancer, HPV testing alone is insufficient to rule out all recurrences. Its role is also unclear in patients after hysterectomy for invasive cancer and in those whose preinvasive lesions regressed spontaneously.