Clinical characteristics and diagnostic performance of vaginal squamous cell carcinoma after hysterectomy

Vaginal squamous cell carcinoma (SCC) is a rare gynecological malignancy. Current guidelines do not recommend routine cancer screening after hysterectomy for non-cervical conditions based on the assumption of negligible risk. However, clinical characteristics of vaginal SCC in post-hysterectomy women remain inadequately defined, particularly for those with non-cervical indications.

We conducted a retrospective cohort study of 227 patients with vaginal SCC diagnosed at a Chinese tertiary center between 2017 and 2025. Clinical characteristics, high-risk human papillomavirus (HPV) status, diagnostic yields of cytology, colposcopy, ultrasound and MRI, and latency from hysterectomy to cancer diagnosis were analyzed.

We found that 66.5% (151/227) of vaginal SCC cases occurred in women with prior hysterectomy; 86.1% had surgery for cervical lesions and 13.9% for non-cervical indications. The overall high-risk HPV positivity rate was 94.7%, with HPV16 predominating (74.9%). Regular post-hysterectomy surveillance was associated with earlier stage at diagnosis: 90.6% of surveilled patients presented with stage I disease versus 65.8% of non-surveilled patients. Latency to diagnosis was significantly shorter for women with prior cervical lesions (median 46.5 versus 120 months). Cytology and colposcopy demonstrated diagnostic yields exceeding 90%, while imaging showed lower detection rates.

Vaginal SCC after hysterectomy is predominantly HPV-driven, including in women with non-cervical indications. Regular post-hysterectomy surveillance is strongly associated with earlier stage at diagnosis. While universal screening is not warranted due to disease rarity, these findings support individualized HPV-informed risk counseling for sexually active women after hysterectomy and reinforce current surveillance recommendations for those with prior cervical lesions.