title: Surveillance for recurrent cancers and vaginal epithelial lesions in patients with invasive cervical cancer after hysterectomy: are vaginal cytology and high-risk human papillomavirus testing useful?
abstract: OBJECTIVE
  To examine whether women who have had a hysterectomy for cervical cancer may be at an increased risk of vaginal epithelial lesions.
  
  
  METHODS
  We studied 147 patients with invasive cervical carcinoma (76 squamous cell carcinomas [SCCs], 60 adenocarcinomas [ADCs], and 11 adenosquamous cell carcinomas) who were treated by hysterectomy and had vaginal pathologic follow-up for a mean period of 43.3 months.
  
  
  RESULTS
  Of the patients, 15.0% (22/147) developed vaginal intraepithelial neoplasia (VAIN) or recurrence after hysterectomy, including two recurrent carcinomas and eight high-grade VAINs. More important, these high-grade VAINs or recurrent carcinomas were detected only in patients with cervical SCC within the first two years after hysterectomy but not in patients with cervical ADC. Eleven (23.4%) of 47 patients had at least one positive high-risk human papillomavirus (hrHPV) testing result during the follow-up period, and VAIN was detected in 54.5% (6/11) of patients with an hrHPV-positive result compared with 16.7% (6/36) with an hrHPV-negative result.
  
  
  CONCLUSIONS
  Our results indicate that women with cervical cancer are at an increased risk of VAIN besides recurrence, and women with cervical SCC are more prone to high-grade VAIN/recurrence, especially within the first two years after hysterectomy. The significantly increased detection rate of VAINs/recurrence in the hrHPV-positive group suggests vaginal cytology and HPV cotesting might be the preferred method for surveillance in these women.
authors.affiliation: zhaoc@upmc.edu.
authors.forename: Zaibo
authors.initials: Z
authors.lastname: Li
authors.forename: Stacey
authors.initials: S
authors.lastname: Barron
authors.forename: Wei
authors.initials: W
authors.lastname: Hong
authors.forename: Arivarasan
authors.initials: A
authors.lastname: Karunamurthy
authors.forename: Chengquan
authors.initials: C
authors.lastname: Zhao
mesh_terms: D000328:Adult; D000368:Aged; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery; D055088:Early Detection of Cancer / Q000379:methods*; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D061809:Human Papillomavirus DNA Tests; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016609:Neoplasms, Second Primary; D030361:Papillomavirus Infections / Q000175:diagnosis*; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery; D014625:Vaginal Neoplasms / Q000473:pathology* / Q000601:surgery; D014626:Vaginal Smears / Q000379:methods*
keywords: Cervical cancer; Cytologic follow-up; Histologic follow-up; Hysterectomy; Vaginal carcinoma; Vaginal intraepithelial neoplasia