April 4th, 2020

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Title:
Cytology and Human Papillomavirus Surveillance in Cervical Cancer: A Low Yield Practice
Authors:  Lisa A. Rauh, M.D., M.P.H., Erin J. Saks, M.D., Olivia M. Moskowitz, M.D., Leigh A. Cantrell, M.D., M.S.P.H., and Linda R. Duska, M.D., M.P.H.
  OBJECTIVE: To determine the impact of Pap smear screening as part of cervical cancer surveillance in the detection of centrally recurrent disease.

STUDY DESIGN: Retrospective review of women with at least 1 Pap smear as part of cervical cancer surveillance. Chi-squared and Wilcoxon rank sum tests were used where appropriate.

RESULTS: A total of 226 women were included. Of those, 10% had stage IA disease, 38.0% (n = 86) had stage IB1 disease, and 52.4% (n=118) had locally advanced cervical cancer, stage IB2–IVA. A total of 1,223 Pap smears were performed in follow-up. Patients treated with radiation were more likely to have an abnormal Pap smear (p= 0.0005). Thirty-four patients (15.0%) were diagnosed with recurrent disease; 8 patients had a central recurrence, 5 had lesions apparent on examination, 2 had pain warranting imaging, and 1 patient (2.9% of all recurrences) was diagnosed by Pap smear alone. A high-grade Pap smear was associated with recurrence (20.6% vs. 8.9%, p=0.04). High-risk human papillomavirus (HPV) results were not significantly different between those who did and did not recur (p=0.86).

CONCLUSION: Neither routine Pap smear in cervical cancer surveillance nor HPV testing appear to be an effective method in the diagnosis of salvageable recurrences.
Keywords:  cervical can­cer, cervix uteri/patholo­gy, colposcopy, diagnostic yield, fertility preserva­tion, HPV, human papil­lomavirus, human pap­ illomavirus DNA tests, neoplasm recurrence, neo­plasm staging, Papanicolaou test, practice guide­ lines as topic, recurrence, uterine cervical neo­plasms, vaginal smears
   
   
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