title: Cervicovaginal cytology in the detection of recurrence after cervical cancer treatment.
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).
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  II.
authors.affiliation: From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and the Division of Biostatistics, Washington University School of Medicine and Siteman Cancer Center, St. Louis, Missouri; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, Kentucky; and the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama-Birmingham, Birmingham, Alabama.
authors.forename: B J
authors.initials: BJ
authors.lastname: Rimel
authors.forename: Aaron
authors.initials: A
authors.lastname: Ferda
authors.forename: Jamie
authors.initials: J
authors.lastname: Erwin
authors.forename: Summer B
authors.initials: SB
authors.lastname: Dewdney
authors.forename: Leigh
authors.initials: L
authors.lastname: Seamon
authors.forename: Feng
authors.initials: F
authors.lastname: Gao
authors.forename: Christopher
authors.initials: C
authors.lastname: DeSimone
authors.forename: Kristen K
authors.initials: KK
authors.lastname: Cotney
authors.forename: Warner
authors.initials: W
authors.lastname: Huh
authors.forename: L Stewart
authors.initials: LS
authors.lastname: Massad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002584:Cervix Uteri / Q000473:pathology*; D003127:Colposcopy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000473:pathology; D009367:Neoplasm Staging; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D014621:Vagina / Q000473:pathology*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology