title: Recurrent smear abnormalities where repeat loop treatment is not possible: is hysterectomy the answer?
abstract: OBJECTIVE
  The objective of this study was to determine the outcome of women who underwent hysterectomy for recurrent cytological abnormalities where repeat loop treatment was considered not to be technically possible because of insufficient remaining cervical tissue.
  
  
  METHODS
  Women undergoing a hysterectomy for the above indication at the Northern Gynaecological Cancer Centre over a period of 10 years (1992-2001) were identified from a prospectively collected database. Case notes were then reviewed and women undergoing hysterectomy for other indications were excluded. Relevant demographic and clinical data were then extracted.
  
  
  RESULTS
  33 patients meeting the above criteria were identified. The overall hysterectomy rate for this indication was 0.73%. 20 out of the 33 women had significant pathology on the hysterectomy specimen. 95% of these had high-grade disease with one having a Stage 1A1 squamous carcinoma. None of the patients required more radical treatment than a simple hysterectomy. There were no major complications following the hysterectomy. Positive endocervical margins on the previous loop specimen (P = 0.05) was an important correlating factor predicting the presence of CIN on the hysterectomy specimen. One out of the thirty hysterectomies (3.3%) performed using the vaginal route had incomplete excision compared to one of three (33%) using the abdominal route. Hysterectomy was successful in treating 85.2% of the women; only 4 women subsequently developed vaginal intraepithelial neoplasia.
  
  
  CONCLUSIONS
  Simple hysterectomy appears to be a suitable diagnostic and treatment option for women with recurrent high-grade cytological abnormalities where further loop treatment is technically not possible. Incomplete excision at the endocervical margin on the previous loop specimen was the main factor associated with the presence of cervical intraepithelial neoplasia at hysterectomy.
authors.affiliation: Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Sheriff Hill, Gateshead NE9 6SX, UK. nagindradas@doctorsnet.org.uk
authors.forename: Nagindra
authors.initials: N
authors.lastname: Das
authors.forename: R
authors.initials: R
authors.lastname: Naik
authors.forename: S
authors.initials: S
authors.lastname: Jackson
authors.forename: A
authors.initials: A
authors.lastname: De Barros Lopes
authors.forename: J M
authors.initials: JM
authors.lastname: Monaghan
authors.forename: K A
authors.initials: KA
authors.lastname: Godfrey
authors.forename: M H
authors.initials: MH
authors.lastname: Hatem
mesh_terms: D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000473:pathology* / Q000601:surgery*; D003127:Colposcopy; D019092:Conization; D000075202:Contraindications; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000517:prevention & control* / Q000601:surgery; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000601:surgery