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Cytologic screening after hysterectomy for benign disease
J T Piscitelli1, L A Bastian, A Wilkes
1Division of General Obstetrics-Gynecology, Duke University, Durham, NC, USA.
American Journal of Obstetrics and Gynecology
|August 1, 1995
Summary
Vaginal cytology screening after hysterectomy for benign conditions is largely ineffective. A history of cervical cytology abnormalities increases risk, but overall, few cases of vaginal dysplasia are detected, suggesting reduced screening is warranted.
Area of Science:
- Gynecologic Oncology
- Cytopathology
Background:
- Hysterectomy for benign conditions is a common procedure.
- Post-hysterectomy vaginal cytology screening aims to detect dysplasia and carcinoma.
- The effectiveness of routine screening in this population is debated.
Purpose of the Study:
- To evaluate the diagnostic yield of vaginal cytology tests in women who have undergone hysterectomy for benign gynecologic disease.
- To identify risk factors associated with abnormal vaginal cytology findings post-hysterectomy.
Main Methods:
- Retrospective cohort study of 697 women over 9074 woman-years.
- Exclusion of patients with a history of gynecologic malignancy.
- Kaplan-Meier estimates and proportional hazards regression used to analyze the development of vaginal cytologic abnormalities.
Main Results:
- 33 abnormal vaginal cytology results were identified; most lacked clinical significance.
- Two cases of biopsy-proven vaginal dysplasia were detected.
- A history of cervical cytologic abnormality was associated with a 4.67-fold increased risk of abnormal vaginal cytology.
- 633 tests were required to detect one case of vaginal dysplasia.
Conclusions:
- The incidence of vaginal dysplasia and carcinoma is low in women post-hysterectomy for benign disease.
- High false-positive rates render routine screening less effective.
- Reducing the frequency of vaginal cytology screening for these low-risk patients is recommended.
