Cytologic screening after hysterectomy for benign disease

Am J Obstet Gynecol. 1995 Aug;173(2):424-30; discussion 430-2. doi: 10.1016/0002-9378(95)90262-7.


Objective: Our purpose was to determine the effectiveness of vaginal cytology tests after hysterectomy for benign disease.

Study design: We studied a 10-year retrospective cohort of patients after hysterectomy (n = 697 women, 9074 woman years). Patients were excluded if they had any type of invasive gynecologic malignancy. The main outcome variable was development of a vaginal cytologic abnormality, evaluated with Kaplan-Meier estimates and proportional hazards regression.

Results: We found 33 abnormal cytology results; most were of little clinical significance except for two biopsy-proven dysplasia cases. When we controlled for age, the risk was 4.67 for patients with a history of a cervical cytologic abnormality (95% confidence interval 2.1 to 10.6). We needed 633 tests to detect one true positive case of vaginal dysplasia.

Conclusions: The low incidence of vaginal dysplasia and carcinoma, combined with the high false-positive rate, supports decreasing the number of screening tests performed for these low-risk patients.

MeSH terms

  • Adult
  • Biopsy
  • Cervix Uteri / pathology
  • Cytodiagnosis / economics
  • False Positive Reactions
  • Female
  • Genital Diseases, Female / surgery
  • Humans
  • Hysterectomy*
  • Life Tables
  • Middle Aged
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • Vagina / pathology*
  • Vaginal Neoplasms / diagnosis*
  • Vaginal Neoplasms / economics
  • Vaginal Smears