Routine Vaginal Cuff Smear Testing
Background: By the age of 60 years, an estimated 33% of women will have undergone a hysterectomy. Approximately 85% of these hysterectomies are performed for benign disease. The object of this study was to evaluate cytologic findings from vaginal cuff smears in patients who have undergone hysterectomy for benign uterine conditions.
Methods: We conducted a community-based retrospective study and follow-up of women with vaginal cuff cytologic smears who had had a hysterectomy for benign uterine conditions. A total of 220 women were randomly selected who had one or more vaginal cuff smears. The main outcomes measures were invasive carcinoma, dysplastic lesions, and infections detected by vaginal cuff smear testing. The setting was a large inner-city hospital.
Results: Ninety-seven percent of 220 women who underwent hysterectomy for benign uterine conditions and who were observed for an average of 89 months had no cytologic abnormalities on vaginal cuff smears. Cytologic evaluation found no invasive carcinomas. Dysplastic lesions were detected in 7 patients (3%). Seventy percent of patients (n = 154) had one or more infections; these infections included bacterial vaginosis (106), trichomoniasis (95), candidiasis (40), koilocytosis suggestive of human papilloma virus (HPV) infection (3), and cytopathic effect of herpes (4). The prevalence of koilocytosis was much higher in the patients with dysplasia (P = .0003).
Conclusions: Most routine vaginal cuff cytology screening tests need not be performed in women who have had a hysterectomy for benign uterine conditions.
Many women in the United States undergo hysterectomy for benign gynecologic conditions. An estimated more than 33% of women in the United States will undergo hysterectomy by the age of 60 years. Approximately 85% of these operations are done for benign disease. The Papanicolaou smear was originally designed to detect cervical carcinomas. Its primary current use is to detect premalignant and malignant cervical lesions. The incidence of vaginal cancers as well as dysplasia in women who have had a hysterectomy for benign conditions is low. The incidence of primary vaginal carcinoma is far less than that of cervical and endometrial carcinomas. The American Cancer Society estimated 2300 new cases of primary vaginal carcinomas in the US general population for 1999. In contrast, there were an estimated 37,400 new cases of endometrial cancers and 12,800 projected cases of cervical cancers for the same period. There was previously no consensus regarding cytologic testing of vaginal cuff smears in the follow-up of these patients for surveillance of vaginal malignancies. A recent study of vaginal smear findings in more than 5,000 women who had undergone hysterectomy concluded that periodic routine screening by means of vaginal Papanicolaou smears is probably not necessary for women whose indication for hysterectomy was benign. This study addressed current negative findings on smears but did not observe the outcome of these patients with time.
Our study differs from previous studies in that we included patients with high-grade prehysterectomy precursor lesions in the study group, and we observed patients with abnormal posthysterectomy findings to assess a long-term outcome. Although vaginal cuff smears appear not to be cost-effective as a screening tool for detection of vaginal lesions, many physicians perform routine vaginal cuff smears for cytologic follow-up. The current guidelines from professional organizations do not provide a clear consensus regarding the use of vaginal cuff cytologic testing in patients who have had a hysterectomy for benign uterine conditions. To investigate the usefulness of vaginal cuff cytologic testing in women who have had a hysterectomy for benign conditions, we analyzed results of vaginal cuff smears in a cohort of 220 women cared for at Grady Memorial Hospital. This hospital serves a predominantly inner-city, lower socioeconomic community in Atlanta.
Background: By the age of 60 years, an estimated 33% of women will have undergone a hysterectomy. Approximately 85% of these hysterectomies are performed for benign disease. The object of this study was to evaluate cytologic findings from vaginal cuff smears in patients who have undergone hysterectomy for benign uterine conditions.
Methods: We conducted a community-based retrospective study and follow-up of women with vaginal cuff cytologic smears who had had a hysterectomy for benign uterine conditions. A total of 220 women were randomly selected who had one or more vaginal cuff smears. The main outcomes measures were invasive carcinoma, dysplastic lesions, and infections detected by vaginal cuff smear testing. The setting was a large inner-city hospital.
Results: Ninety-seven percent of 220 women who underwent hysterectomy for benign uterine conditions and who were observed for an average of 89 months had no cytologic abnormalities on vaginal cuff smears. Cytologic evaluation found no invasive carcinomas. Dysplastic lesions were detected in 7 patients (3%). Seventy percent of patients (n = 154) had one or more infections; these infections included bacterial vaginosis (106), trichomoniasis (95), candidiasis (40), koilocytosis suggestive of human papilloma virus (HPV) infection (3), and cytopathic effect of herpes (4). The prevalence of koilocytosis was much higher in the patients with dysplasia (P = .0003).
Conclusions: Most routine vaginal cuff cytology screening tests need not be performed in women who have had a hysterectomy for benign uterine conditions.
Many women in the United States undergo hysterectomy for benign gynecologic conditions. An estimated more than 33% of women in the United States will undergo hysterectomy by the age of 60 years. Approximately 85% of these operations are done for benign disease. The Papanicolaou smear was originally designed to detect cervical carcinomas. Its primary current use is to detect premalignant and malignant cervical lesions. The incidence of vaginal cancers as well as dysplasia in women who have had a hysterectomy for benign conditions is low. The incidence of primary vaginal carcinoma is far less than that of cervical and endometrial carcinomas. The American Cancer Society estimated 2300 new cases of primary vaginal carcinomas in the US general population for 1999. In contrast, there were an estimated 37,400 new cases of endometrial cancers and 12,800 projected cases of cervical cancers for the same period. There was previously no consensus regarding cytologic testing of vaginal cuff smears in the follow-up of these patients for surveillance of vaginal malignancies. A recent study of vaginal smear findings in more than 5,000 women who had undergone hysterectomy concluded that periodic routine screening by means of vaginal Papanicolaou smears is probably not necessary for women whose indication for hysterectomy was benign. This study addressed current negative findings on smears but did not observe the outcome of these patients with time.
Our study differs from previous studies in that we included patients with high-grade prehysterectomy precursor lesions in the study group, and we observed patients with abnormal posthysterectomy findings to assess a long-term outcome. Although vaginal cuff smears appear not to be cost-effective as a screening tool for detection of vaginal lesions, many physicians perform routine vaginal cuff smears for cytologic follow-up. The current guidelines from professional organizations do not provide a clear consensus regarding the use of vaginal cuff cytologic testing in patients who have had a hysterectomy for benign uterine conditions. To investigate the usefulness of vaginal cuff cytologic testing in women who have had a hysterectomy for benign conditions, we analyzed results of vaginal cuff smears in a cohort of 220 women cared for at Grady Memorial Hospital. This hospital serves a predominantly inner-city, lower socioeconomic community in Atlanta.