title: A common clinical dilemma: Management of abnormal vaginal cytology and human papillomavirus test results.
abstract: 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 (hrHPV) tests, and clinicians are faced with managing their abnormal results. Our objective is to review the literature on vaginal cytology and hrHPV testing and to develop guidance for the management of abnormal vaginal screening tests.
  
  
  
  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.
  
  
  
  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 post-treatment for cervical precancer or cancer, hrHPV testing may be useful in identification of vaginal cancer precursors.
  
  
  
  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: Division of Women's Reproductive Healthcare, Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA. Electronic address: mjkhan@uabmc.edu.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Khan
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: L Stewart
authors.initials: LS
authors.lastname: Massad
authors.affiliation: Department of Women's Health, The Permanente Medical Group, Sacramento, CA, USA.
authors.forename: Walter
authors.initials: W
authors.lastname: Kinney
authors.affiliation: Tulsa Cancer Institute, University of Oklahoma, School of Community Medicine, Tulsa, OK, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gold
authors.affiliation: Department of Family and Preventive Medicine, Department of Obstetrics and Gynecology, University of South Carolina School of Medicine, Columbia, SC, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Mayeaux
authors.affiliation: Department of Clinical Pathology, University of California, San Francisco, CA, USA.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Darragh
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Philip E
authors.initials: PE
authors.lastname: Castle
authors.affiliation: Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Chelmow
authors.affiliation: Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Herschel W
authors.initials: HW
authors.lastname: Lawson
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
authors.forename: Warner K
authors.initials: WK
authors.lastname: Huh
mesh_terms: D005260:Female; D006801:Humans; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D011230:Precancerous Conditions / Q000473:pathology / Q000821:virology; D014621:Vagina / Q000166:cytology* / Q000473:pathology / Q000821:virology*; D014625:Vaginal Neoplasms / Q000473:pathology / Q000821:virology; D014626:Vaginal Smears / Q000379:methods*
keywords: HPV; VaIN; Vaginal cancer; Vaginal cytology