Is Isthmic-Vaginal Cytology Smear Effective in Detecting Post-Radical Trachelectomy Recurrence of Cervical Cancer?
Z Ghorab, S Nofech-Mozes, N Ismiil, A Covens, RS Saad, V Dube, MA Khalifa. Sunnybrook Health Sciences Centre, Toronto, Canada
Background: Radical trachelectomy is a fertility-preserving alternative for patients with early cervical cancer. According to our local, previously described protocol, postoperative follow up includes isthmic-vaginal cytology smear (IVCS) scheduled every 3 months for 2 years, every 6 months for 3 years, and then yearly. The aim of this study is to assess the role of cytology in early detecting of recurrence.
Design: A total of 94 patients treated with radical trachelectomy (1994 – 2007) with pertinent pathological, clinical and follow up data were identified from our prospective database. Within the follow up period, 913 IVCS were generated. These were evaluated by a group of cytopathologists.
Results: There were 1 – 27 smears per patient (median = 10). Seventy of the 94 patients (74.5%) had at least one abnormal IVCS, of which 45.7% had initial positive smears that subsequently converted to negative. Abnormal results included ASC-US (40.2%), AGC (41.9%), LSIL (11%), HSIL (4.6%), ASC-H (0.9%) and positive for malignant cells (1.4%). Within the follow up period of 1 – 149 months (median = 51 months), the only 2 central recurrences were successfully diagnosed by smears. One patient had no clinical findings except for an HSIL + AGC IVCS that was followed, 2 months later, by a cone biopsy confirming recurrence. The other had abnormal cervix and an IVCS reported as adenocarcinoma, confirmed by a concurrent biopsy. Pelvic (non-central) recurrence detected by pelvic CT occurred in 3 additional patients (IVCS was negative in 2 and HSIL in one). Although the negative predictive value in this series was 100%, the percentage of abnormal IVCS was high, mostly due to lower uterine segment endometrial cells and reactive postoperative changes.
Conclusions: This study confirms the role of IVCS in the early detection of central recurrence. More effective triage strategies are needed to identify the minority of women who will likely recur centrally to avoid unnecessary anxiety and the additional follow-up testing caused by the high percentage of abnormal results. The available evidence does, however, suggest that IVCS has a very low positive predictive value when used as a screening tool in the absence of symptoms or clinical signs.
Tuesday, March 23, 2010 9:30 AM
Poster Session III # 81, Tuesday Morning