Skip Navigation LinksHome > September 2011 - Volume 118 - Issue 3 > Cervicovaginal Cytology in the Detection of Recurrence After...
Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e3182271fdd
Original Research

Cervicovaginal Cytology in the Detection of Recurrence After Cervical Cancer Treatment

Rimel, B. J. MD; Ferda, Aaron MD; Erwin, Jamie MD; Dewdney, Summer B. MD; Seamon, Leigh DO, MPH; Gao, Feng PhD; DeSimone, Christopher MD; Cotney, Kristen K.; Huh, Warner MD; Massad, L. Stewart MD

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Abstract

OBJECTIVE: To evaluate the utility of liquid-based cytology in detecting recurrent cervical cancer among treated cervical cancer patients.

METHODS: A retrospective multi-institution study identified patients treated for cervical cancer from January 1, 2000, to November 1, 2009, through local cancer registries and patient databases. Patients were excluded if they lacked follow-up or treatment data.

RESULTS: In all, 4,167 cytology results from 929 women were identified. Of these, 626 (15%) Pap test results from 312 (34%) women were abnormal, including 296 atypical squamous cells of undetermined significance (ASC-US; 47%); 179 low-grade squamous intraepithelial lesions (LSIL; 29%), 59 atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions (ASC-H; 9%); 55 high-grade squamous intraepithelial lesions (HSIL; 9%); 14 atypical glandular cells (2%), and 23 favor neoplasia (4%). Abnormal Pap test results led to 201 colposcopies in 135 women. Only 45 women had cervical intraepithelial neoplasia (CIN) 2 or worse, 25 had CIN 3, and 12 had cancer. Only 5 of 475 (1%) women with ASC-US or LSIL had CIN 3. Cancer recurred in 147 women, with 12 (8.1%) detected by Pap test; all but one had Pap test results of ASC-H or worse. One patient with ASC-US and human papillomavirus had a visible lesion on return for assessment 2 months after Pap testing. Colposcopy for cytology less than HSIL without a visible lesion on examination did not detect any recurrence or CIN 3. When stratified by stage and institution, patients treated with radiation had a higher risk of abnormal Pap test results (P<.001).

CONCLUSION: A third of cervical cancer survivors will have abnormal cytology during follow-up, but in the absence of a visible lesion, those with ASC-US or LSIL can be followed without colposcopy unless abnormalities persist. Women with ASC-H, HSIL, and similar abnormalities deserve colposcopy.

LEVEL OF EVIDENCE: II

© 2011 by The American College of Obstetricians and Gynecologists.

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