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Objectives To examine whether women who have had a hysterectomy for cervical cancer may be at an increased risk of vaginal epithelial lesions. Methods We studied 147 patients with invasive cervical carcinoma (76 squamous cell carcinomas [SCCs], 60 adenocarcinomas [ADCs], and 11 adenosquamous cell carcinomas) who were treated by hysterectomy and had vaginal pathologic follow-up for a mean period of 43.3 months. Results Of the patients, 15.0% (22/147) developed vaginal intraepithelial neoplasia (VAIN) or recurrence after hysterectomy, including two recurrent carcinomas and eight high-grade VAINs. More important, these high-grade VAINs or recurrent carcinomas were detected only in patients with cervical SCC within the first two years after hysterectomy but not in patients with cervical ADC. Eleven (23.4%) of 47 patients had at least one positive high-risk human papillomavirus (hrHPV) testing result during the follow-up period, and VAIN was detected in 54.5% (6/11) of patients with an hrHPV-positive result compared with 16.7% (6/36) with an hrHPV-negative result. Conclusions Our results indicate that women with cervical cancer are at an increased risk of VAIN besides recurrence, and women with cervical SCC are more prone to high-grade VAIN/recurrence, especially within the first two years after hysterectomy. The significantly increased detection rate of VAINs/recurrence in the hrHPV-positive group suggests vaginal cytology and HPV cotesting might be the preferred method for surveillance in these women.

Objectives: Our study examined accumulated data on vaginal cytology follow-up results of women treated for endometrial carcinoma (EmCa) by hysterectomy in a large academic women’s hospital practice. Methods: This study analyzed cases of EmCa treated by hysterectomy from January 2006 to December 2008 with documented follow-up vaginal cytology and/or vaginal biopsy results available prior to September 2013. Results: Of 607 patients with EmCa who had documented hysterectomy findings, 420 had either follow-up vaginal biopsy or cytology results during a mean follow-up period of 42.5 months, and 414 (98.6%) had at least one vaginal cytology follow-up result. Of 414 patients followed with vaginal cytology results, 48 (11.6%) had biopsy results while 366 (88.4%) had only vaginal cytology results. Recurrent EmCa in the vagina was documented by biopsy in 11 patients, eight within 2 years of hysterectomy. Cytology findings of neoplastic glandular cells triggered diagnostic vaginal biopsies in two of 11 cases. Conclusions: Vaginal recurrences of EmCa were diagnosed in 11 (2.6%) of 420 patients with documented vaginal follow-up testing. Abnormal vaginal cytology findings directly led to vaginal biopsy diagnoses of EmCa in two of the 11 patients. Vaginal cytology is no longer a recommended routine surveillance option for detection of vaginal cuff recurrence of EmCa.

To examine whether women who have had a hysterectomy for cervical cancer may be at an increased risk of vaginal epithelial lesions.We studied 147 patients with invasive cervical carcinoma (76 squamous cell carcinomas [SCCs], 60 adenocarcinomas [ADCs], and 11 adenosquamous cell carcinomas) who were treated by hysterectomy and had vaginal pathologic follow-up for a mean period of 43.3 months.Of the patients, 15.0% (22/147) developed vaginal intraepithelial neoplasia (VAIN) or recurrence after hysterectomy, including two recurrent carcinomas and eight high-grade VAINs. More important, these high-grade VAINs or recurrent carcinomas were detected only in patients with cervical SCC within the first two years after hysterectomy but not in patients with cervical ADC. Eleven (23.4%) of 47 patients had at least one positive high-risk human papillomavirus (hrHPV) testing result during the follow-up period, and VAIN was detected in 54.5% (6/11) of patients with an hrHPV-positive result compared with 16.7% (6/36) with an hrHPV-negative result.Our results indicate that women with cervical cancer are at an increased risk of VAIN besides recurrence, and women with cervical SCC are more prone to high-grade VAIN/recurrence, especially within the first two years after hysterectomy. The significantly increased detection rate of VAINs/recurrence in the hrHPV-positive group suggests vaginal cytology and HPV cotesting might be the preferred method for surveillance in these women.