[1178] The Utility of Vaginal Pap Test in Patients with Endometrial Carcinoma Post Hysterectomy

Arivarasan Karunamurthy, Sarika Jain, Chengquan Zhao. University of Pittsburgh Medical Center, Pittsburgh, PA

Background: Endometrial cancer is the most common gynecologic malignancy in developed countries and surgery is the standard treatment. New screening guidelines does not emphasize if vaginal screening test is needed for patients with endometrial carcinoma after hysterectomy. Our aim was to evaluate the utility of the vaginal Pap test for women with endometrial carcinoma post hysterectomy.
Design: A retrospective review of all cases of endometrial carcinoma who underwent hysterectomy at our institution over a period of 17 months was performed to look at the clinical data, histological diagnosis at the time of surgery, cytological and histological follow-up results.
Results: A total of 227 patients underwent hysterectomy for endometrial carcinomas and the hystrectomy specimens included 120 (53%) endometrioid carcinoma, 26 (11%) serous carcinoma, 7 (3%) clear cell carcinoma, 3 (1%) malignant mixed mulerian tumor and 5 (2%) other types of carcinomas. The mean age of the patients was 62.3 years (range 27-91 years) and, 161 (71%) patients had vaginal histological and/or cytological results in our database during the follow-up period. The mean follow-up period was 43 months (range: 3 to 80 months) and the number of follow up Pap smears visits averaged 6.4 times (range: 1 to 16 times). The follow-up histological and cytological results were summarized in Table 1.

Table 1. Summary of follow-up cytological & histological results
Follow-up Histo-Cytological Results(Total cases)CarcinomaVAIN2/3 & HSILVAIN1/LSILAtypical Squamous lesionNegative
Histology17203012
Cytology Only14400118125
Total Cases161 (100%)2 (1%)04 (2%)18 (11%)137 (85%)


Two cases (1%) were detected with vaginal adenocarcinoma (recurrent endometrial carcinoma) at 5 months and 26 months post treatment by both vaginal cytology and biopsy. Four (2.5%) cases developed vaginal intraepithelial neoplasia 1(VAIN1) or low grade squamous intraepithelial (LSIL) lesions and no vaginal intraepithelial neoplasia 2/3 (VAIN 2/3) or high grade squamous intraepithelial lesion (HSIL) were identified during the follow-up period.
Conclusions: Vaginal cuff cytology for women with endometrial carcinoma after hysterectomy may play two functions including surveillance of endometrial carcinoma recurrences and the screening of vaginal dysplasia or cancer. The majority of recurrences occur within three years after hysterectomy. No high grade dysplasia was identified during the period of 4 years. We suggest that these women should not be regularly screened after three years of hysterectomy. More larger case series studies are needed.
Category: Gynecologic & Obstetrics

Tuesday, March 5, 2013 9:30 AM

Poster Session III # 132, Tuesday Morning

 

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