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A Common Clinical Dilemma

Management of Abnormal Vaginal Cytology and Human Papillomavirus Test Results

Khan, Michelle J. MD, MPH; Massad, L. Stewart MD; Kinney, Walter MD; Gold, Michael A. MD; Mayeaux, EJ Jr. MD; Darragh, Teresa M. MD; Castle, Philip E. PhD, MPH; Chelmow, David MD; Lawson, Herschel W. MD; Huh, Warner K. MD

Journal of Lower Genital Tract Disease: April 2016 - Volume 20 - Issue 2 - p 119–125
doi: 10.1097/LGT.0000000000000185
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Objective Vaginal cancer is an uncommon cancer of the lower genital tract, and standardized screening is not recommended. Risk factors for vaginal cancer include a history of other lower genital tract neoplasia or cancer, smoking, immunosuppression, and exposure to diethylstilbestrol in utero. Although cervical cancer screening after total hysterectomy for benign disease is not recommended, many women inappropriately undergo vaginal cytology and/or human papillomavirus (HPV) tests, and clinicians are faced with managing their abnormal results. Our objectives were to review the literature on vaginal cytology and high-risk HPV (hrHPV) testing and to develop guidance for the management of abnormal vaginal screening tests.

Materials and Methods An electronic search of the PubMed database through 2015 was performed. Articles describing vaginal cytology or vaginal hrHPV testing were reviewed, and diagnostic accuracy of these tests when available was noted.

Results The available literature was too limited to develop evidence-based recommendations for managing abnormal vaginal cytology and hrHPV screening tests. However, the data did show that (1) the risk of vaginal cancer in women after hysterectomy is extremely low, justifying the recommendation against routine screening, and (2) in women for whom surveillance is recommended, e.g., women posttreatment for cervical precancer or cancer, hrHPV testing may be useful in identification of vaginal cancer precursors.

Conclusions Vaginal cancer is rare, and asymptomatic low-risk women should not be screened. An algorithm based on expert opinion is proposed for managing women with abnormal vaginal test results.

After hysterectomy, HSIL and cancer of the vagina are rare; we propose a conservative approach to management of abnormal vaginal cytology and/or high-risk HPV tests.

1Department of Obstetrics and Gynecology, Division of Women's Reproductive Healthcare, University of Alabama at Birmingham School of Medicine, Birmingham, AL; 2Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University School of Medicine, St. Louis, MO; 3Department of Women's Health, the Permanente Medical Group, Sacramento, CA; 4Tulsa Cancer Institute and University of Oklahoma School of Community Medicine, Tulsa, OK; 5Departments of Family and Preventive Medicine and Obstetrics and Gynecology, University of South Carolina School of Medicine, Columbia, SC; 6Department of Clinical Pathology, University of California, San Francisco, CA; 7Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY; 8Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA; 9Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA; and 10Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, AL

Reprint requests to: Michelle J. Khan, MD, MPH; University of Alabama at Birmingham, 1700 6th Avenue, South WIC 10261, Birmingham, AL 35249. E-mail: mjkhan@uabmc.edu

The authors have declared they have no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.jlgtd.com). This Review is published simultaneously in Gynecologic Oncology and the Journal of Lower Genital Tract Disease.

Copyright © 2016 by the American Society for Colposcopy and Cervical Pathology