Abstract 1305: Comparison of HPV-DNA testing to PET-CT imaging as prognostic test following definitive treatment for cervical cancer: A retrospective proof-of-concept study
Authors: Huddleston Cameron , Fakhreddine Aya Bou , Stroever Stephanie , Young Robert , Sah Naresh , Palle Komaraiah , Reedy Mark 
Published: March 2024

Cervical cancer is a significant global health issue, with oncogenic HPV-High Risk (HPV) responsible for over 99% of cases. Despite the prevalence of HPV-related malignancies, current guidelines by the National Comprehensive Cancer Center (NCCN) do not recommend post-treatment HPV-DNA testing. Instead, PET-CT imaging is recommended as a prognostic test. This retrospective proof-of-concept study aims to evaluate current NCCN guidelines and examines whether post-treatment HPV-HR DNA testing is a cost-effective, reliable alternative to PET-CT imaging in cervical cancer prognosis.

Methods: The study included female patients diagnosed with cervical or vaginal carcinomas (2011-2021), ensuring comprehensive records of both pre-treatment and post-treatment high-risk HPV (HPV-HR) testing, alongside PET-CT imaging results. Utilizing the FDA-approved HPV-HR DNA test, capable of detecting 14 oncogenic HPV strains, the study conducted rigorous statistical analyses via STATA software to determine significance of the study results.

Results: Our analysis of 53 patients who met the inclusion criteria demonstrated that post-treatment assessments using both HPV status and PET-CT imaging exhibited high levels of sensitivity and specificity, as well as impressive negative and positive predictive values (NPV and PPV, respectively). There was a statistically significant correlation between the likelihood of cancer recurrence and the results obtained from HPV status and PET-CT imaging post-treatment (p-value &lt; 0.001). A critical observation was the superior sensitivity and improved NPV of post-treatment HPV status compared to PET-CT scans. Specifically, the sensitivity for HPV status post-treatment was quantified at 92.31, surpassing the 76.92 sensitivity rating of PET-CT scans. Furthermore, the NPV for post-treatment HPV status was measured at 97.44, which is better than the 92.31 NPV for PET-CT scans. Notably, no patients with negative post-treatment HPV-HR tests had a recurrence.

Discussion: The results of this study underscore the clinical significance of assessing HPV-HR DNA status post-treatment, particularly when HPV-HR DNA is negative. If future prospective studies confirm these findings, it may eliminate the need for post-treatment PET-CT scans, providing significant survivorship benefits for patients by reducing follow-up visits and eliminating unnecessary imaging. This would also result in substantial financial savings, estimated to be over $75,000,000 per year in the US alone, based on 2023 data. The limitations of the study include small sample size, single-institution data, and biases associated with retrospective studies. Future multi-institutional prospective studies are necessary to improve current guidelines further and validate the findings of this study.

Citation Format: Cameron Huddleston, Aya Bou Fakhreddine, Stephanie Stroever, Robert Young, Naresh Sah, Komaraiah Palle, Mark Reedy. Comparison of HPV-DNA testing to PET-CT imaging as prognostic test following definitive treatment for cervical cancer: A retrospective proof-of-concept study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1305.