Déterminants virologiques de la discordance entre la biopsie diagnostique du col et l’histologie finale au traitement
Introduction: A persistent infection by high-risk HPV can cause high-grade cervical lesions (HSIL).  Women diagnosed by biopsy-proven HSIL undergo treatment by conisation (LEEP). LEEP can confirm HSIL or may have normal/LSIL pathology on treatment histology. Those women were treated unnecessarily. This discrepancy can be attributed to spontaneous clearance of HSIL, or errors in initial pathology readings. Objectives: To investigate if virus-related variables are associated with normal/LSIL LEEP pathology after an HSIL biopsy (discrepancy). Methods: CoHIPP is a randomized trial conducted in 13 colposcopy centers across Canada, comparing follow-up strategies after HSIL treatment. Out of women in CoHIPP, we selected 355 cases of discrepancy and matched them with 355 controls. We conducted conditional univariate logistic regression and univariate analysis to assess the association between clinical variables and viral variables (genotype, viral load and polymorphism). Genotype was obtained by Hybrid Capture 2 and Linear Array, viral load by real time PCR and polymorphism by sequencing. Results: Cases and controls did not differ in terms of age and delay between diagnostic and treatment. The absence of HR-HPV at baseline (treatment) was significantly associated with an increased risk of discrepancy (OR: 23,60 95% CI: 9,83-74,03). The only HPV genotypes associated with the lowest risk of discrepancy were types 16, 31, 33 or 52. HPV 16 (compared to no HPV or low risk HPV) had the strongest association against discrepancy. Viral load and polymorphism analysis were not good predictors of discrepancy.  Discussion/Conclusions: Future research should investigate the use of generic HR-HPV testing pre-treatment to identity women with HSIL biopsy who could be safely followed-up instead of being treated.
LEEP Cervical conization HPV High-grade squamous intraepithelial lesion LSIL HSIL