title: Cytological follow-up after hysterectomy: is vaginal vault cytology sampling a clinical governance problem? The University Hospital of North Staffordshire approach.
abstract: OBJECTIVE
  Vaginal vault cytology sampling following hysterectomy is recommended for specific indications in national guidelines. However, clinical governance issues surround compliance with guidance. Our first study objective was to quantify how many patients undergoing hysterectomy at the University Hospital of North Staffordshire (UHNS) had vault cytology advice in their histology report and, if indicated, whether it was arranged. The second was to devise a vault cytology protocol based on local experience and national guidance.
  
  
  METHODS
  The local cancer registry was searched. Clinical, clerical and histological data for all patients undergoing hysterectomy were collected.
  
  
  RESULTS
  In total, 271 patients were identified from both the gynae-oncology and benign gynaecology teams. Of these, 24% (65/271) were gynae-oncology patients with a mean age of 69 years. The benign gynaecology team had 76% (206/271) of patients with a mean age of 55 years. Subsequently, 94% (256/271) had cytology follow-up advice in their histopathology report. Ultimately, from both cohorts, 39% (18/46) had follow-up cytology performed when indicated.
  
  
  CONCLUSIONS
  A high proportion of cases complied with national guidance. However, a disappointingly high number did not have vault cytology sampling when this was indicated. This is probably a result of the complex guidance that is misunderstood in both primary and secondary care. Vault follow-up of patients after hysterectomy rests with the team performing the surgery. Vault cytology, if indicated, should be performed in secondary care and follow-up should be planned. The protocol set out in this article should be followed to avoid unnecessary clinical governance failings.
authors.affiliation: University Hospital of North Staffordshire, Staffordshire, UK.
authors.forename: W
authors.initials: W
authors.lastname: Parry-Smith
authors.affiliation: University Hospital of North Staffordshire, Staffordshire, UK.
authors.forename: D
authors.initials: D
authors.lastname: Thorpe
authors.affiliation: University Hospital of North Staffordshire, Staffordshire, UK.
authors.forename: L
authors.initials: L
authors.lastname: Ogboro-Okor
authors.affiliation: Royal Shrewsbury Hospital, Shropshire, UK.
authors.forename: M
authors.initials: M
authors.lastname: Underwood
authors.affiliation: University Hospital of North Staffordshire, Staffordshire, UK.
authors.forename: E
authors.initials: E
authors.lastname: Ismaili
authors.affiliation: University Hospital of North Staffordshire, Staffordshire, UK.
authors.forename: M
authors.initials: M
authors.lastname: Kodampur
authors.affiliation: University Hospital of North Staffordshire, Staffordshire, UK.
authors.forename: R
authors.initials: R
authors.lastname: Todd
authors.affiliation: University Hospital of North Staffordshire, Staffordshire, UK.
authors.forename: G
authors.initials: G
authors.lastname: Douce
authors.affiliation: University Hospital of North Staffordshire, Staffordshire, UK.
authors.forename: C W E
authors.initials: CW
authors.lastname: Redman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054976:Clinical Governance; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D014626:Vaginal Smears / Q000706:statistics & numerical data*
keywords: cytology; follow-up; hysterectomy; national guidance; vaginal vault; vault cytology; vault smear