Cervicovaginal cytology in the detection of recurrence after cervical cancer treatment.

Academic Article

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.
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    Keywords

  • Adult, Aged, Aged, 80 and over, Cervical Intraepithelial Neoplasia, Cervix Uteri, Colposcopy, Female, Humans, Middle Aged, Neoplasm Recurrence, Local, Neoplasm Staging, Retrospective Studies, Uterine Cervical Neoplasms, Vagina, Vaginal Smears
  • Digital Object Identifier (doi)

    Author List

  • Rimel BJ; Ferda A; Erwin J; Dewdney SB; Seamon L; Gao F; DeSimone C; Cotney KK; Huh W; Massad LS
  • Start Page

  • 548
  • End Page

  • 553
  • Volume

  • 118
  • Issue

  • 3