title: Usefulness of vaginal cytology tests in women with previous hysterectomy for benign diseases: assessment of 53,891 tests.
abstract: OBJECTIVE
  To assess the value of vaginal screening cytology after hysterectomy for benign disease.
  
  
  METHODS
  This cross-sectional study used cytology audit data from 2,512,039 screening tests in the metropolitan region of Campinas from 2000 to 2012; the object was to compare the prevalence of abnormal tests in women who had undergone a hysterectomy for benign diseases (n=53,891) to that of women who had had no hysterectomy. Prevalence ratios (95% confidence intervals, 95% CI) were determined, and chi-square analysis, modified by the Cochrane-Armitage test for trend, was used to investigate the effects of age.
  
  
  RESULTS
  The prevalence of atypical squamous cells (ASC), low-grade squamous intraepithelial lesion (LSIL), and high-grade squamous intraepithelial lesion or squamous-cell carcinoma (HSIL/SCC) was 0.13%, 0.04% and 0.03%, respectively, in women who had undergone hysterectomy, and 0.93%, 0.51% and 0.26% in women who had not undergone hysterectomy. The prevalence ratios for ASC, LSIL and HSIL/SCC were 0.14 (0.11-0.17), 0.08 (0.06-0.13) and 0.13 (0.08-0.20), respectively, in women with a hysterectomy versus those without. For HSIL/SCC, the prevalence ratios were 0.09 and 0.29, respectively, for women <50 or ≥50 years. The prevalence rates in women with a previous hysterectomy showed no significant variation with age.
  
  
  CONCLUSIONS
  The prevalence rates of ASC, LSIL and HSIL/SCC were significantly lower in women with a previous hysterectomy for benign disease compared with those observed in women with an intact uterine cervix. This study reinforces the view that there is no evidence that cytological screening is beneficial for women who have had a hysterectomy for benign disease.
authors.affiliation: Department of Obstetrics and Gynecology, State University of Campinas - Unicamp, School of Medicine, 13083-888 Campinas, SP, Brazil.
authors.forename: Diama Bhadra
authors.initials: DB
authors.lastname: Vale
authors.affiliation: Department of Obstetrics and Gynecology, State University of Campinas - Unicamp, School of Medicine, 13083-888 Campinas, SP, Brazil.
authors.forename: Joana Froes
authors.initials: JF
authors.lastname: Bragança
authors.affiliation: Department of Pathology, State University of Sao Paulo, UNESP, School of Medicine, 18618-970 Botucatu, SP, Brazil.
authors.forename: José Cândido Caldeira
authors.initials: JC
authors.lastname: Xavier-Junior
authors.affiliation: Department of Pathology, State University of Sao Paulo, UNESP, School of Medicine, 18618-970 Botucatu, SP, Brazil.
authors.forename: Rozany Mucha
authors.initials: RM
authors.lastname: Dufloth
authors.affiliation: Department of Obstetrics and Gynecology, State University of Campinas - Unicamp, School of Medicine, 13083-888 Campinas, SP, Brazil.
authors.forename: Sophie
authors.initials: S
authors.lastname: Derchain
authors.affiliation: Department of Obstetrics and Gynecology, State University of Campinas - Unicamp, School of Medicine, 13083-888 Campinas, SP, Brazil. Electronic address: zeferino@fcm.unicamp.br.
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: Zeferino
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D002577:Uterine Cervical Diseases / Q000601:surgery*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014626:Vaginal Smears / Q000379:methods* / Q000592:standards*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology
keywords: Guideline adherence; Hysterectomy; Mass screening; Uterine cervical neoplasms; Vaginal neoplasms