Vaginal vault smears after hysterectomy for reasons other than malignancy: a systematic review of the literature.
ABSTRACT 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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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. · 1.09 Impact Factor
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ABSTRACT: The practice of vaginal smears after total hysterectomy should be discussed according to the indication for hysterectomy. We have thus performed a literature review using PubMed medical database with selection of articles presenting a practical interest for clinicians. The practice of vaginal smears after endometrial cancer can be abandoned, but in case of cervical cancer it improves the performance of clinical examination in the early follow-up (in the first 5 years of follow-up) especially in early diagnosis of subclinical recurrence. After this period, the interest of vaginal smears drop drastically and the follow-up is mainly clinical. When hysterectomy is proposed as part of cervical intraepithelial neoplasia (particularly when associated uterine lesions and cervical conization not accessible), the risk of vaginal recurrence of HPV-induced pathology fully justifies an annual monitoring (recurrences or virus-induced lesions are seen up to 25 years after surgery). Finally, after hysterectomy for benign uterine non-HPV-induced, there is no need to propose a systematic follow-up cytology.Gynécologie Obstétrique & Fertilité 03/2013; 41(3):196–200. · 0.55 Impact Factor
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ABSTRACT: Guidelines for cervical cancer screening have continued to evolve as we have accumulated new information about the pathogenesis of cervical cancer and the role of the human papilloma virus. Most recently, the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology issued revised joint recommendations for the prevention and early detection of cervical cancer. In addition, the US Preventative Services Task Force revised its guidelines, and the American College of Obstetricians and Gynecologists updated its practice bulletin.Obstetrics and Gynecology Clinics of North America 06/2013; 40(2):211-23. · 1.45 Impact Factor