***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND In this study , our prospect i ve experience with a multimodal follow-up protocol is summarized , with special emphasis on predicting the treatment outcome of cervical diseases . MATERIAL S AND METHODS Liquid-based cytology sample s ( ThinPrep ) from 209 women exhibiting the whole spectrum of human papilloma virus (HPV)-related cervical diseases were investigated by cytology , PCR-based HPV genotyping and DNA cytometry pre-surgery . The first control cytology and type-specific HPV tests were performed at 3 months post-surgery . RESULTS The success rate of surgery was 95 % in eradicating high- grade cervical disease and 90 % in eliminating the baseline HPV genotype . Treatment failure was significantly correlated with baseline cytology ( p=0.011 ) , resection margin status ( p=0.016 ) and HPV positivity at 3 months post-surgery ( p=0.04 ) . Multivariate logistic regression analysis showed that type-specific persistent HPV infection ( p=0.028 ) , baseline cytology ( p=0.039 ) and histology ( p=0.065 ) were independent predictors of residual cervical neoplasias . CONCLUSION Our results showed that our multimodal surveillance protocol may help to individually assess the anticipated clinical outcome of cervical diseases post-surgery Cervical intraepithelial neoplasia 3 ( CIN3 ) is the precursor of mostsquamous carcinomas and serves as a surrogate end point . However , small CIN3 lesions are rarely associated with concurrent invasion . We hypothesized that aggressive follow-up for cytology of atypical squamous cells of undetermined significance ( ASCUS ) or low- grade squamous intraepithelial lesion ( LSIL ) leads predominantly to detection of smaller CIN3 lesions than those usually associated with cancer . We assessed this hypothesis in a masked histopathologic review of 330 CIN3 lesions in the ASCUS LSILTriage Study , focusing on ASCUS referrals . ASCUS referrals underwent r and omized management [ colposcopy for repeat cytology of high- grade squamous intraepithelial lesion ( HSIL ) , colposcopy for oncogenic human papillomavirus ( HPV ) detection or repeat HSIL , or immediate colposcopy ] ; then all were followed with repeat cytology for 2 years , followed by colposcopy and aggressive treatment . We assessed all CIN3 lesions qualitatively and measured 39 of them . CIN3 lesions were overwhelmingly small . Compared with enrollment , lesions found at follow-up or exit involved fewer tissue fragments ( P < 0.01 ) and showed less diffuse gl and involvement ( P = 0.03 ) . CIN3 lesions found postenrollment after HPV testing involved the fewest tissue fragments [ versus immediate colposcopy ( P = 0.04 ) or repeat cytology of HSIL ( P = 0.02 ) ] , and none showed diffuse gl and involvement . The median distal-proximal length was 6.5 mm ( median replacement of total epithelium = 5 % ) in the 39 measured cases . We conclude that CIN3 lesions underlying ASCUS or LSIL generally lack features associated with invasion , particularly if managed using HPV testing , suggesting that aggressive management leads to early detection of CIN3 but probably prevents relatively few cancers in screened population OBJECTIVE To evaluate testing for high-risk human papillomavirus ( HR HPV ) E6/E7 mRNA transcripts 6 months after conisation for cervical intraepithelial neoplasia grade 2 or worse ( CIN2 + ) to determine the risk of residual CIN2 + . METHODS We prospect ively followed 344 women treated for CIN2 + by conisation .  HR HPV mRNA testing ( PreTect HPV-Proofer , NorChip ® ) , HR HPV DNA testing ( AMPLICOR HPV Test , Roche Diagnostics ® ) and cytology  was performed at 6 and 12 months after conisation . Biopsies were taken within 18 months of conisation if indicated by abnormal cytology , abnormal colposcopy , or positive HPV test . The LINEAR ARRAY HPV Genotyping Test ( Roche Diagnostics ® ) was used to genotype cases with histologically confirmed residual disease diagnosed within 18 months after conisation . RESULTS 6.4 % ( 22/344 ) of study women had detected residual CIN2 + . They were significantly older than those without residual CIN2 + ( 43.2 and 37.2 years respectively , p<0.001 ) . Among women with detected residual CIN2 + , 54.5 % ( 12/22 ) had positive resection margins , 63.6 % ( 14/22 ) had abnormal cytology , and 95.5 % ( 21/22 ) had a positive HR HPV DNA test at 6 months . Sensitivity of HR HPV mRNA testing was 45.5 % ( 95 % confidence interval : 26.8 - 65.5 % ) at 6 months to predict detected residual CIN2 + . Eight of 12 women who were HR HPV mRNA-negative at 6 months were HR HPV DNA-positive for one of the HPV types included in the mRNA test . CONCLUSION Detection of E6/E7 mRNA transcripts by PreTect HPV Proofer does not seem suitable for short-term follow-up to detect residual CIN2 + after conisation OBJECTIVE : To estimate the effectiveness of the human papillomavirus ( HPV ) test performed after conization in predicting residual disease in patients who subsequently underwent hysterectomy . METHODS : A total of 115 patients who underwent hysterectomy after conization caused by cervical intraepithelial neoplasia grade 3 ( CIN 3 ) and microinvasive cervical cancer ( IA1 cancer ) were included in this prospect i ve study . All patients underwent HPV testing with a liquid hybridization assay immediately before hysterectomy .  Differences in sensitivity , specificity , and accuracy between resection margin and the HPV test in predicting residual disease in subsequent hysterectomy sample s were estimated using the McNemar exact test . RESULTS : Univariable analysis showed that age , parity , menopausal status , gl and ular extension , and severity of disease were not predictive for residual disease , but positive resection margin and positive HPV tests were significant factors for predicting residual disease . These factors were also significant in a multivariable analysis ( positive resection margin 45.5 % , odds ratio [ OR ] 3.09 , 95 % confidence interval [ CI ] 1.19–8.03 , P=.021 ; positive HPV test 57.6 % , OR 11.05 , 95 % CI 4.01–30.49 , P<.001 ) . With resection margin , the sensitivity , specificity , and accuracy in predicting residual disease were 75 % , 53 % , and 61 % , respectively , whereas , with the HPV test , these values were 85 % , 67 % , and 73 % , respectively ( P=.454 , .080 , and .044 , respectively ) . Of patients with positive resection margins , 79 % of HPV-negative patients had no residual disease . Of patients with negative resection margins , no HPV-negative patient had residual disease . CONCLUSION : The HPV test after conization was significantly more accurate than resection margin for predicting residual disease . The predictive value of resection margin for predicting residual disease was much improved when used in combination with the HPV test . Use of the HPV test is recommended for identifying patients for subsequent hysterectomy after conization for CIN 3 and IA1 cancer . LEVEL OF EVIDENCE : AIM To investigate the therapeutic efficacy of cylindrical or cone-shaped excision performed by laser CO2 in the conservative management of persistent-recurrent high- grade cervical intraepithelial neoplasia ( HG-CIN ) in women of fertile age . PATIENTS AND METHODS Ninety-four premenopausal patients with persistent-recurrent HG-CIN had undergone re-conization or cylindrical excision according to the time of reappearance of the disease . The length of the procedures , intra- and postoperative complications , height of the excised specimens , final histological findings and follow-up data were retrospectively evaluated . RESULTS Fifty-five ( 58.5 % ) persistent and 39 ( 41.5 % ) recurrent cases had undergone cylindrical excision and st and ard re-conization respectively . All the treatments were successfully performed in an out-patient setting under local anesthesia with no differences in term of operative time , height of removed specimens , intra- and postoperative complications between the two groups . Definitive histology confirmed HG-CIN in 95.7 % of the cases and FIGO Stage Ia1 cervical cancer ( negative lymph vascular space involvement , LVSI ) in 4.3 % of the cases . The endocervical margins were involved in 3.6 % of the cylindrical ( persistent ) and in 17.9 % of the cone-shaped ( recurrent ) specimens ( p = 0.03 ) . The overall cure rate after a median follow-up time of 54 months ( range 10 - 196 ) was 91.5 % . A third excisional procedure was performed in 8 cases of persistent-recurrent HG-CIN with a disease-free subsequent follow-up of 38 months ( range 6 - 108 ) . CONCLUSION Cylindrical or conical re-excision performed by CO2 laser according to the time of reappearance of the disease seems to be a promising conservative approach for persistent-recurrent HG-CIN even though further r and omised prospect i ve studies are needed to confirm the long-term efficacy and reproductive outcomes OBJECTIVES Loop electrosurgical excision of the transformation zone ( LEETZ ) was recently associated with relatively high failure rates . We evaluated whether the combination of LEETZ with laser vaporization is superior to LEETZ alone in reducing the rates of recurrent abnormal cytology and residual disease . METHODS The study population included 426 women with histologic diagnosis of cervical intraepithelial neoplasia ( CIN ) 2 - 3 , of whom 289 ( study group ) were treated by  LEETZ followed by laser vaporization of the crater base and walls and 137 ( control group ) were treated by LEETZ alone . All women were followed scrupulously at regular intervals for recurrent abnormal cytology and residual disease . The mean follow-up periods were 43 and 59 months for the study and control groups , respectively . RESULTS Both groups were derived from the same community and were similar in epidemiologic characteristics and disease severity . Although the incidence of positive surgical margins was similar in both groups ( 10.4 and 9.5 % for the study and control groups , respectively ) , recurrent abnormal cytology ( 10.2 % vs 5.5 % , P = 0.07 ) and histologic residual disease ( 21.4 % vs 0 % , P = 0.05 ) were more frequent among women in the control group . This applied to women with both negative and positive surgical margins . Both study and control women with positive surgical margins , especially at the endocervix , were at higher risk for recurrence . CONCLUSION The addition of laser vaporization to LEETZ may improve outcome of both women with positive margins and women with negative margins . Our results support conservative management for all treated women , regardless of cone margin status OBJECTIVE The goal of this study was to determine/evaluate the negative predictive value of human papillomavirus ( HPV ) testing following conization of cervix uteri . METHODS A prospect i ve analysis was undertaken on 79 cone biopsies of women with high- grade lesions ( cervical intraepithelial neoplasia ( CIN ) III ) .  HPV testing  was performed on cervical smears before and after conization . We correlated the margin status ( defined as positive cone margin or endocervical curettage status ) and positive conization HPV status with the residual disease in a hysterectomy specimen . A Digene II kit was used to perform HPV testing .  HPV detection was done by Hybrid Capture assay . RESULTS Of the 79 patients , 47(59.5 % ) had positive margins after conization . HPV testing was positive in 37 cases ( 78.7 % ) and negative in 10 cases ( 21.3 % ) . Residual disease was found in 31 of 47 ( 66 % ) postconization hysterectomy specimens . No residual lesions were found in HPV-negative cases . Of the 32 cases with negative margins following conization , HPV testing was negative in 25 cases ( 78 % ) and was positive in 7 cases ( 22 % ) . Among these 25 cases with negative HPV tests , no residual lesion was detected , and in 7 HPV-positive cases , only one residual lesion was found . CONCLUSION HPV testing is potentially an effective tool in predicting residual dysplasia after conization and could potentially assist in the decision between hysterectomy and conservative follow-up in women with CIN III Objective To evaluate whether microcolposcopic topographic endocervical assessment reduces the failures of excisional treatment of cervical intraepithelial neoplasia ( C 
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INTERPRETATION The risk of residual or recurrent CIN2 + is significantly greater with involved margins on excisional treatment ; however , high-risk HPV post-treatment predicts treatment failure more accurately than margin status .