Vaginal vault smears after hysterectomy for reasons other than malignancy: A systematic review of literature

Department of Primary Care and General Practice, University of Birmingham, UK.
BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.45). 12/2006; 113(12):1354-65. DOI: 10.1111/j.1471-0528.2006.01099.x
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Vaginal vault smears are used to detect persisting neoplasia of the lower genital tract after hysterectomy. Recent data suggest both widespread use and uncertain evidence of their effectiveness.
To identify and synthesise evidence on the use and effectiveness of vaginal vault smears and to assess the quality. SEARCH STRATEGY 'vault smear' OR 'vaginal vault smear' OR 'cervical vault smear' OR ('Hysterectomy') AND ('Follow up' OR 'Smear'). SELECTION CRITERIA Primary research, women who had a hysterectomy and were followed up by vault cytology.
Systematic search (eight electronic databases), supplemented by contact with experts and review of bibliographies. Two independent reviewers determined eligibility/validity and extracted data concerning test performance characteristics. Quality was assessed according to the established criteria.
Of 441 unique references, only 19 were suitable. Quality of studies varied considerably and few were of 'high' methodological quality. Studies were geographically diverse, and were published over more than 40 years in 16 journals. From the higher scoring papers, there were 11 659 hysterectomies [6546, benign; 76, cervical intraepithelial neoplasia (CIN) I/CIN II; 5037, CIN III]. Proportions of abnormal vault smears and abnormal biopsies during follow up increased with worsening histology at hysterectomy (P < 0.0001 and P = 0.0001). There was only one report of vaginal cancer subsequent to hysterectomy for CIN and insufficient data to allow for reliable meta-analysis.
Vault smears cause anxiety, consume resources and their value is largely unproven. Inconsistency of study design and limited methodological quality means that the value of vault smears could not be established. High-quality research is required to ensure that the guidelines are evidence based.

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Available from: Sean Kehoe, Jul 02, 2015
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    • "Vaginal intraepithelial neoplasia (VAIN) and vaginal carcinoma are rare clinical entities. Human papillomavirus infection, immunosuppression, radiation therapy, and smoking are reported to be the risk factors [1]. Upper vaginectomy is a technique applicable to the patients with cervical cancer after simple hysterectomy, vaginal recurrence of endometrial cancer, vaginal intraepithelial neoplasia, and superficially invasive vaginal carcinoma. "
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    ABSTRACT: Background The aim of this study is to describe the feasibility and efficacy of the laparoscopic upper vaginectomy (LUV) in vaginal intraepithelial neoplasia(VAIN) and superficially invasive vaginal carcinoma. Methods We studied patients with vaginal intraepithelial neoplasia (VAIN) 2, VAIN 3, and superficially invasive vaginal carcinoma after hysterectomy who have been under laparoscopic upper vaginectomy between March 2010 and March 2012. Results Four patients underwent LUV after hysterectomy for high risk VAIN and early vaginal cancer. The mean age was 50.8 (range 40–56) years; the mean operation time was 162.5 (range 145–205) minutes; and the mean estimated blood loss was 55 (range 20–100) ml. All the patients restituted bladder function after the removal of the foley catheter. Mean hospital stay was 2 days. Two patients had postoperative complications. One patient with warfarin administration had vaginal stump bleeding and another developed vesico-vaginal fistula. Three of the patients had no residual lesion, but 1 patient had VAIN 1 in the resection margin. Colposcopy was followed on all patients and cytology proved no recurrence. Conclusions LUV after hysterectomy is a feasible procedure and attentively applicable to high risk VAIN or superficially invasive vaginal carcinoma.
    World Journal of Surgical Oncology 06/2013; 11(1):126. DOI:10.1186/1477-7819-11-126 · 1.41 Impact Factor
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    • "The majority of published studies recommend the use of vaginal vault smears in the follow-up of women who have had a hysterectomy subsequent to the diagnosis of an invasive tumour of the cervix uteri, or where invasive disease is an incidental finding at hysterectomy [8-12]. A systematic review of the literature [13] could identify no robust controlled trials that establish the value of the follow-up, by vault smears, for women who have had a hysterectomy for benign indications. The available evidence does, however, suggest that the vault smear test has a very low positive predictive value when used as a screening tool in the absence of symptoms or clinical signs [8,9,14]. "
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    ABSTRACT: 20% of women living in the UK have a hysterectomy during their lifetime, levels are higher in the USA, making it one of the most commonly performed major surgical procedures. Understanding of the indications for hysterectomy and of the rationale for follow-up of women post hysterectomy is currently limited. Guidelines concerning follow-up by means of vaginal vault cytology tests exist but these are not based on 'gold standard' evidence. Furthermore, the extent to which current practice reflects these guidelines is unclear. This study aims to determine the factors associated with variability in hysterectomy rates and subsequent follow-up after surgery by use of the vaginal vault smear cytology test. All women resident in the West Midlands region, of the United Kingdom, who had a hysterectomy operation between 1st April 2002 and 30th March 2003 will be identified from the Hospital Episodes Statistics database which also contains proxy data on deprivation status, derived from postcode and self declared ethnicity. These data will be linked to regional cervical screening records for each woman and histopathology laboratory records from the relevant hospitals. Study objectives are to describe: Indications for the hysterectomy operation, histology at hysterectomy, subsequent follow-up by use or non-use of vaginal vault cytology tests and variation between histological groups. Additionally the data will be categorised according to a woman's cytology screening history prior to surgery (i.e. always normal, borderline, resolved abnormalities, CIN etc) and these different groups compared. Variations in these outcomes according to age, deprivation and ethnic group will also be examined. Analysis will be undertaken using SPSS. This study will clarify patterns of current practice in one large English region and determine whether this practice reflects existing guidelines. The study will also strengthen the evidence base for future guidelines. National Research Register N0138173331.
    BMC Women's Health 02/2008; 8(1):6. DOI:10.1186/1472-6874-8-6 · 1.50 Impact Factor
  • Primary Care Clinics in Office Practice 04/2007; 34(1):137-67. DOI:10.1016/j.pop.2007.02.002 · 0.74 Impact Factor
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