Page 30 - Strategies for non-invasive managementof high-grade cervical intraepithelial neoplasia - prognostic biomarkers and immunotherapy Margot Maria Koeneman

Chapter 2
Abstract
The natural history of high-grade cervical intraepithelial neoplasia (CIN) is largely unpredictable and current histopathological examination is unable to differentiate between lesions that will regress or not. Therefore, most high-grade lesions are currently treated by surgical excision, leading to overtreatment and unnecessary complications. Prognostic biomarkers may differentiate between lesions that will regress or not, making individualized treatment of high-grade CIN possible. This review identified several promising prognostic biomarkers. These biomarkers include viral genotype and viral DNA methylation (viral factors), HLA-subtypes, markers of lymphoproliferative response, telomerase amplification and HPV-induced epigenetic effects (host factors) and Ki67, p53 and pRb (cellular factors). All identified biomarkers were evaluated according to their role in the natural history of high-grade CIN and according to established criteria for evaluation of biomarkers (PROBE-criteria). None of the biomarkers meet the PROBE criteria for clinical applicability. More research on prognostic biomarkers in high-grade CIN is necessary.
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