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

doi: 10.1097/AOG.0b013e3182271fdd
Original Research

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

Low-grade cytology can be followed in the absence of a visible lesion in cervical cancer survivors, but high-grade cytology in this group requires further evaluation.

From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and the Division of Biostatistics, Washington University School of Medicine and Siteman Cancer Center, St. Louis, Missouri; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, Kentucky; and the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama-Birmingham, Birmingham, Alabama.

Presented as a poster at the 2011 Annual Meeting of the Society of Gynecologic Oncologists, March 3–9, 2011, Orlando, Florida.

Corresponding author: B. J. Rimel, MD, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University School of Medicine, 4911 Barnes-Jewish Plaza, Box 8064, St. Louis, MO 63110; e-mail: rimelb@wudosis.wustl.edu.

Financial Disclosure Dr. Huh is a consultant for Roche Molecular Systems and Qiagen. The other authors did not report any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.