title: A Common Clinical Dilemma: Management of Abnormal Vaginal Cytology and Human Papillomavirus Test Results.
abstract: OBJECTIVE
  Vaginal cancer is an uncommon cancer of the lower genital tract, and standardized screening is not recommended. Risk factors for vaginal cancer include a history of other lower genital tract neoplasia or cancer, smoking, immunosuppression, and exposure to diethylstilbestrol in utero. Although cervical cancer screening after total hysterectomy for benign disease is not recommended, many women inappropriately undergo vaginal cytology and/or human papillomavirus (HPV) tests, and clinicians are faced with managing their abnormal results. Our objectives were to review the literature on vaginal cytology and high-risk HPV (hrHPV) testing and to develop guidance for the management of abnormal vaginal screening tests.
  
  
  METHODS
  An electronic search of the PubMed database through 2015 was performed. Articles describing vaginal cytology or vaginal hrHPV testing were reviewed, and diagnostic accuracy of these tests when available was noted.
  
  
  RESULTS
  The available literature was too limited to develop evidence-based recommendations for managing abnormal vaginal cytology and hrHPV screening tests. However, the data did show that (1) the risk of vaginal cancer in women after hysterectomy is extremely low, justifying the recommendation against routine screening, and (2) in women for whom surveillance is recommended, e.g., women posttreatment for cervical precancer or cancer, hrHPV testing may be useful in identification of vaginal cancer precursors.
  
  
  CONCLUSIONS
  Vaginal cancer is rare, and asymptomatic low-risk women should not be screened. An algorithm based on expert opinion is proposed for managing women with abnormal vaginal test results.
authors.affiliation: 1Department of Obstetrics and Gynecology, Division of Women's Reproductive Healthcare, University of Alabama at Birmingham School of Medicine, Birmingham, AL; 2Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University School of Medicine, St. Louis, MO; 3Department of Women's Health, the Permanente Medical Group, Sacramento, CA; 4Tulsa Cancer Institute and University of Oklahoma School of Community Medicine, Tulsa, OK; 5Departments of Family and Preventive Medicine and Obstetrics and Gynecology, University of South Carolina School of Medicine, Columbia, SC; 6Department of Clinical Pathology, University of California, San Francisco, CA; 7Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY; 8Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA; 9Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA; and 10Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Khan
authors.forename: L Stewart
authors.initials: LS
authors.lastname: Massad
authors.forename: Walter
authors.initials: W
authors.lastname: Kinney
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gold
authors.forename: E J
authors.initials: EJ
authors.lastname: Mayeaux
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Darragh
authors.forename: Philip E
authors.initials: PE
authors.lastname: Castle
authors.forename: David
authors.initials: D
authors.lastname: Chelmow
authors.forename: Herschel W
authors.initials: HW
authors.lastname: Lawson
authors.forename: Warner K
authors.initials: WK
authors.lastname: Huh
mesh_terms: D000465:Algorithms; D019090:Case Management / Q000458:organization & administration*; D005260:Female; D061809:Human Papillomavirus DNA Tests; D006801:Humans; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000628:therapy*; D014625:Vaginal Neoplasms / Q000175:diagnosis* / Q000628:therapy*