The utility and management of vaginal cytology after treatment for endometrial cancer

Akiva P. Novetsky, Lindsay M. Kuroki, L. Stewart Massad, Andrea R. Hagemann, Premal H. Thaker, Matthew A. Powell, David G. Mutch, Israel Zighelboim

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

OBJECTIVE: To estimate the accuracy of vaginal cytology in postoperative surveillance for detecting recurrent endometrial cancer and to estimate the optimal management of squamous abnormalities detected in this setting. METHODS: This review included women who underwent hysterectomy for endometrial cancer between January 1, 2006, and December 31, 2010, and had at least one postoperative Pap test. Clinical and demographic data were collected and outcomes including abnormal vaginal cytology, results of colposcopic examination, and endometrial cancer recurrence were assessed. A Cox regression model to estimate the risk of abnormal cytology was created. Sensitivity, specificity, and negative and positive predictive values of detecting vaginal recurrences were calculated. RESULTS: Four hundred thirty-three women contributed 2,378 Pap tests. At least one abnormal cytology result was found during follow-up of 55 (13%) women, representing 3% of all Pap tests. No recurrent endometrial cancers were diagnosed on the basis of isolated abnormal cytology. No cases of recurrent cancer were diagnosed in women with atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion (LSIL) Pap test results. In multivariable analysis, abnormal cytology was highly associated with prior postoperative radiation therapy (P<.001). The sensitivity, specificity, and positive and negative predictive values of an abnormal Pap test result in detecting a local recurrence are 40%, 87.9%, 7.3%, and 98.4%, respectively. CONCLUSION: Colposcopy is not needed after a Pap test result read as atypical squamous cells of undetermined significance or LSIL. LEVEL OF EVIDENCE: III

Original languageEnglish (US)
Pages (from-to)129-135
Number of pages7
JournalObstetrics and Gynecology
Volume121
Issue number1
DOIs
StatePublished - Jan 2013
Externally publishedYes

Fingerprint

Papanicolaou Test
Endometrial Neoplasms
Cell Biology
Recurrence
Therapeutics
Sensitivity and Specificity
Colposcopy
Hysterectomy
Proportional Hazards Models
Radiotherapy
Demography
Neoplasms

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Novetsky, A. P., Kuroki, L. M., Massad, L. S., Hagemann, A. R., Thaker, P. H., Powell, M. A., ... Zighelboim, I. (2013). The utility and management of vaginal cytology after treatment for endometrial cancer. Obstetrics and Gynecology, 121(1), 129-135. https://doi.org/10.1097/AOG.0b013e31827499a9

The utility and management of vaginal cytology after treatment for endometrial cancer. / Novetsky, Akiva P.; Kuroki, Lindsay M.; Massad, L. Stewart; Hagemann, Andrea R.; Thaker, Premal H.; Powell, Matthew A.; Mutch, David G.; Zighelboim, Israel.

In: Obstetrics and Gynecology, Vol. 121, No. 1, 01.2013, p. 129-135.

Research output: Contribution to journalArticle

Novetsky, AP, Kuroki, LM, Massad, LS, Hagemann, AR, Thaker, PH, Powell, MA, Mutch, DG & Zighelboim, I 2013, 'The utility and management of vaginal cytology after treatment for endometrial cancer', Obstetrics and Gynecology, vol. 121, no. 1, pp. 129-135. https://doi.org/10.1097/AOG.0b013e31827499a9
Novetsky AP, Kuroki LM, Massad LS, Hagemann AR, Thaker PH, Powell MA et al. The utility and management of vaginal cytology after treatment for endometrial cancer. Obstetrics and Gynecology. 2013 Jan;121(1):129-135. https://doi.org/10.1097/AOG.0b013e31827499a9
Novetsky, Akiva P. ; Kuroki, Lindsay M. ; Massad, L. Stewart ; Hagemann, Andrea R. ; Thaker, Premal H. ; Powell, Matthew A. ; Mutch, David G. ; Zighelboim, Israel. / The utility and management of vaginal cytology after treatment for endometrial cancer. In: Obstetrics and Gynecology. 2013 ; Vol. 121, No. 1. pp. 129-135.
@article{0c35799e583944a9a8567d7ad7f9323a,
title = "The utility and management of vaginal cytology after treatment for endometrial cancer",
abstract = "OBJECTIVE: To estimate the accuracy of vaginal cytology in postoperative surveillance for detecting recurrent endometrial cancer and to estimate the optimal management of squamous abnormalities detected in this setting. METHODS: This review included women who underwent hysterectomy for endometrial cancer between January 1, 2006, and December 31, 2010, and had at least one postoperative Pap test. Clinical and demographic data were collected and outcomes including abnormal vaginal cytology, results of colposcopic examination, and endometrial cancer recurrence were assessed. A Cox regression model to estimate the risk of abnormal cytology was created. Sensitivity, specificity, and negative and positive predictive values of detecting vaginal recurrences were calculated. RESULTS: Four hundred thirty-three women contributed 2,378 Pap tests. At least one abnormal cytology result was found during follow-up of 55 (13{\%}) women, representing 3{\%} of all Pap tests. No recurrent endometrial cancers were diagnosed on the basis of isolated abnormal cytology. No cases of recurrent cancer were diagnosed in women with atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion (LSIL) Pap test results. In multivariable analysis, abnormal cytology was highly associated with prior postoperative radiation therapy (P<.001). The sensitivity, specificity, and positive and negative predictive values of an abnormal Pap test result in detecting a local recurrence are 40{\%}, 87.9{\%}, 7.3{\%}, and 98.4{\%}, respectively. CONCLUSION: Colposcopy is not needed after a Pap test result read as atypical squamous cells of undetermined significance or LSIL. LEVEL OF EVIDENCE: III",
author = "Novetsky, {Akiva P.} and Kuroki, {Lindsay M.} and Massad, {L. Stewart} and Hagemann, {Andrea R.} and Thaker, {Premal H.} and Powell, {Matthew A.} and Mutch, {David G.} and Israel Zighelboim",
year = "2013",
month = "1",
doi = "10.1097/AOG.0b013e31827499a9",
language = "English (US)",
volume = "121",
pages = "129--135",
journal = "Obstetrics and Gynecology",
issn = "0029-7844",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - The utility and management of vaginal cytology after treatment for endometrial cancer

AU - Novetsky, Akiva P.

AU - Kuroki, Lindsay M.

AU - Massad, L. Stewart

AU - Hagemann, Andrea R.

AU - Thaker, Premal H.

AU - Powell, Matthew A.

AU - Mutch, David G.

AU - Zighelboim, Israel

PY - 2013/1

Y1 - 2013/1

N2 - OBJECTIVE: To estimate the accuracy of vaginal cytology in postoperative surveillance for detecting recurrent endometrial cancer and to estimate the optimal management of squamous abnormalities detected in this setting. METHODS: This review included women who underwent hysterectomy for endometrial cancer between January 1, 2006, and December 31, 2010, and had at least one postoperative Pap test. Clinical and demographic data were collected and outcomes including abnormal vaginal cytology, results of colposcopic examination, and endometrial cancer recurrence were assessed. A Cox regression model to estimate the risk of abnormal cytology was created. Sensitivity, specificity, and negative and positive predictive values of detecting vaginal recurrences were calculated. RESULTS: Four hundred thirty-three women contributed 2,378 Pap tests. At least one abnormal cytology result was found during follow-up of 55 (13%) women, representing 3% of all Pap tests. No recurrent endometrial cancers were diagnosed on the basis of isolated abnormal cytology. No cases of recurrent cancer were diagnosed in women with atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion (LSIL) Pap test results. In multivariable analysis, abnormal cytology was highly associated with prior postoperative radiation therapy (P<.001). The sensitivity, specificity, and positive and negative predictive values of an abnormal Pap test result in detecting a local recurrence are 40%, 87.9%, 7.3%, and 98.4%, respectively. CONCLUSION: Colposcopy is not needed after a Pap test result read as atypical squamous cells of undetermined significance or LSIL. LEVEL OF EVIDENCE: III

AB - OBJECTIVE: To estimate the accuracy of vaginal cytology in postoperative surveillance for detecting recurrent endometrial cancer and to estimate the optimal management of squamous abnormalities detected in this setting. METHODS: This review included women who underwent hysterectomy for endometrial cancer between January 1, 2006, and December 31, 2010, and had at least one postoperative Pap test. Clinical and demographic data were collected and outcomes including abnormal vaginal cytology, results of colposcopic examination, and endometrial cancer recurrence were assessed. A Cox regression model to estimate the risk of abnormal cytology was created. Sensitivity, specificity, and negative and positive predictive values of detecting vaginal recurrences were calculated. RESULTS: Four hundred thirty-three women contributed 2,378 Pap tests. At least one abnormal cytology result was found during follow-up of 55 (13%) women, representing 3% of all Pap tests. No recurrent endometrial cancers were diagnosed on the basis of isolated abnormal cytology. No cases of recurrent cancer were diagnosed in women with atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion (LSIL) Pap test results. In multivariable analysis, abnormal cytology was highly associated with prior postoperative radiation therapy (P<.001). The sensitivity, specificity, and positive and negative predictive values of an abnormal Pap test result in detecting a local recurrence are 40%, 87.9%, 7.3%, and 98.4%, respectively. CONCLUSION: Colposcopy is not needed after a Pap test result read as atypical squamous cells of undetermined significance or LSIL. LEVEL OF EVIDENCE: III

UR - http://www.scopus.com/inward/record.url?scp=84872101351&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84872101351&partnerID=8YFLogxK

U2 - 10.1097/AOG.0b013e31827499a9

DO - 10.1097/AOG.0b013e31827499a9

M3 - Article

C2 - 23262937

AN - SCOPUS:84872101351

VL - 121

SP - 129

EP - 135

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

SN - 0029-7844

IS - 1

ER -