Limited value of vaginal cytology in detecting recurrent disease after radical hysterectomy for early stage cervical carcinoma.

The objective of this study was to evaluate the value of vaginal cytology in routine surveillance for recurrent cervical cancer after surgery. We reviewed the medical records of 565 patients with stage IB-IIA cervical cancer who were treated with radical hysterectomy and pelvic lymphadenectomy (RHPL) and attended follow- up at Chiang Mai University Hospital between January 2000 and May 2006. With the median follow-up of 35 months (range 1-76 months), 23 (4%) patients developed recurrence. The interval from surgery to detection of recurrence ranged from 5-61 months with a median of 23 months. Of the total 4,376 vaginal smears, 5 (0.1%) showed abnormal cytology but only 1 had malignant cells and tumor recurrence. The sensitivity and specificity of vaginal cytology for detection of recurrence were 4.3% and 99.3%, respectively. In conclusion, vaginal cytology has limited value in detection of recurrence after RHPL for early-stage cervical cancer.

Northern Thai women with high grade squamous intraepithelial lesion on cervical cytology have high prevalence of underlying invasive carcinoma.

The aim of this study was to determine the underlying pathology of women with high grade squamous intraepithelial lesion (HSIL) on cervical cytology. A total of 681 women with HSIL cytology undergoing colposcopic examination at Chiang Mai University Hospital (CMUH) between January 2000 and December 2005 were evaluated for the underlying cervical pathology. The final pathology was diagnosed from the most severe lesions obtained by punch biopsy, loop electrosurgical procedure, cold knife conization or hysterectomy. Underlying high grade cervical lesions including cervical intraepithelial neoplasia grade 2, 3 and adenocarcinoma in situ were noted in 502 (73.7%) women. Invasive cervical carcinoma was identified in 141 (20.7%). The remaining 38 (5.6%) had either low grade or no intraepithelial lesions. No significant difference in the prevalence of underlying high grade and invasive lesions was noted between women with cytologic diagnosis of HSIL from CMUH and other hospitals. In conclusion, northern Thai women with HSIL cytology are at significant risk of having underlying severe cervical lesions, and especially invasive carcinoma which is detected in approximately one-fifth of the cases.