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Hysterectomy for Abnormal Cervical Smear When Local Excision Is Not Possible

Cheung, Ka Wang MBBS, MRCOG; Cheung, Vincent Y.T. MBBS, FRCOG, FRCSC

Journal of Lower Genital Tract Disease: July 2014 - Volume 18 - Issue 3 - p 235–239
doi: 10.1097/LGT.0b013e3182a42d33
Original Articles

Objective To review the outcomes of those women who underwent hysterectomy because of an abnormal cervical smear where local excision was considered technically not possible.

Materials and Methods A retrospective chart review was performed for all women who had hysterectomy at a university-affiliated hospital, carried out during the period between January 2000 and June 2012, because of cervical neoplasia.

Results Fifty-six women were identified. The mean (standard deviation [SD]) age of the women at the time of hysterectomy was 61.4 (8.2) years. Two women (3.6%) had cervical carcinoma, and adjuvant treatment was required in both cases. Being postmenopausal and older than 50 years and having a history of previous local excisional procedure were associated with a higher risk of high-grade cervical intraepithelial neoplasia found during hysterectomy (p > .005). During a mean (SD) follow-up of 42.3 (30.8) months after hysterectomy, 35.7% of women had persistent cytologic abnormality after hysterectomy, with 19.6% having subsequent histologically proven vaginal intraepithelial neoplasia (VAIN). Women’s age, route of hysterectomy, previous local excision, degree of cytologic abnormality before hysterectomy, presence of VAIN before hysterectomy, and final histology of the hysterectomy specimen could not predict subsequent VAIN after hysterectomy.

Conclusions Hysterectomy seems to be an appropriate option in management, but further surgery or adjuvant therapy may be needed. Women should also be aware of the possibilities of persistent cytologic abnormalities including VAIN, but unfortunately, no predictive factor for its occurrence can be identified.

Hysterectomy is an acceptable option in women with cervical cytologic abnormalities in whom local excisional treatment is technically not possible.

Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China

The authors have stated explicitly that there are no conflicts of interest in connection with this article.

Reprint requests to: Ka Wang Cheung, MBBS, MRCOG, Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Rd, Hong Kong SAR, China. E-mail:

Copyright © 2014 by the American Society for Colposcopy and Cervical Pathology