[450] Vaginal Cytology and HPV Co-Testing Is Preferred for Follow-Up of Women with Invasive Cervical Cancer Treated by Hysterectomy

Chengquan Zhao, Zaibo Li, Stacey Barron, Wei Hong, Arivarasan Karunamurthy. University of Pittsburgh Medical Center, Pittsburgh, PA; Conemaugh Memorial Medical Center, Johnstown, PA

Background: New cervical cancer screening guidelines indicate that women who have undergone hysterectomy and no history of cervical intraepithelial neoplasia (CIN) 2+ should not be screened for vaginal cancer. Women who have had a hysterectomy for invasive cervical cancer/CIN2+ may be at an increased risk of vaginal cancer, but data are very limited.
Design: A computer-based search of CoPath files was carried out to retrieve cases with invasive cervical carcinoma treated by hysterectomy with histopathologic and/or cytologic follow-up results during a study period of 10 years. Surgical pathology reports, follow-up hrHPV testing, cytologic, and histopathologic results were recorded.
Results: 147 patients with invasive cervical carcinoma [76 squamous cell carcinoma (SqCC), 60 adenocarcinoma (ADC) and 11 adenosquamous carcinoma] treated by hysterectomy and follow-up results were identified. The average age of these patients was 43 years (range: 29-72) at the time of diagnosis. The average follow-up period was 43.3 months (range: 3-139). Two cases (1.4%) of recurrent/residual SqCC were detected in vagina/vulva during follow-up, 1 and 11 months after the hysterectomy, respectively. 20 patients (13.6%) developed vaginal intraepithelial neoplasias (VAINs) during follow-up (table 1). The average interval between hysterectomy and initial diagnosis of VAIN2/3/HSIL (8 cases) was 8.6 months (range: 1-24). 47 women had hrHPV testing during follow-up and 29.7 % (11/47) had at least one positive hrHPV testing. Importantly, VIN was detected in 54.5% (6/11) of patients with hrHPV-positive result compared to 16.7% (6/36) of patients with negative hrHPV-negative result.

Vaginal cytologic and histologic follow-up results in 147 patients with invasive cervical carcinoma treated by hysterectomy.
 Case#CarcinomaVIN2/3/HSILVIN1/LSILNeg/ASC
Histology3427916
Cytology only113013109
Total1472812125
Legend: VIN: vaginal intraepithelial neoplasia; H/LSIL: high/low grade intraepithelial lesion; Neg: negative; ASC: atypical squamous cells.


Conclusions: VAIN1+ lesions were identified in 15.0% (22/147) patients with invasive cervical cancer treated by hysterectomy, indicating these women were at an increased risk of vaginal lesion. All VAIN2+ lesions were identified within 2 years after hysterectomy. The significantly increased detection rate of VAINs in hrHPV-positive group suggests vaginal cytology and HPV co-testing is preferred for follow-up of women with invasive cervical carcinoma after hysterectomy.
Category: Cytopathology

Tuesday, March 5, 2013 9:00 AM

Proffered Papers: Section F, Tuesday Morning

 

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