A common clinical dilemma: Management of abnormal vaginal cytology and human papillomavirus test results

Abstract

Objective Vaginal cancer is an uncommon cancer of the lower genital tract, and standardized screening is not recommended. Risk factors for vaginal cancer include a history of other lower genital tract neoplasia or cancer, smoking, immunosuppression, and exposure to diethylstilbestrol in utero. Although cervical cancer screening after total hysterectomy for benign disease is not recommended, many women inappropriately undergo vaginal cytology and/or human papillomavirus (hrHPV) tests, and clinicians are faced with managing their abnormal results. Our objective is to review the literature on vaginal cytology and hrHPV testing and to develop guidance for the management of abnormal vaginal screening tests. Methods An electronic search of the PubMed database through 2015 was performed. Articles describing vaginal cytology or vaginal hrHPV testing were reviewed, and diagnostic accuracy of these tests when available was noted. Results The available literature was too limited to develop evidence-based recommendations for managing abnormal vaginal cytology and hrHPV screening tests. However, the data did show that 1) the risk of vaginal cancer in women after hysterectomy is extremely low, justifying the recommendation against routine screening, and 2) in women for whom surveillance is recommended, e.g. women post-treatment for cervical precancer or cancer, hrHPV testing may be useful in identification of vaginal cancer precursors. Conclusion Vaginal cancer is rare, and asymptomatic low-risk women should not be screened. An algorithm based on expert opinion is proposed for managing women with abnormal vaginal test results.

Relevance of the Pap Test: A Report of HPV-DNA Test-Negative High-Grade Squamous Intraepithelial Lesions of the Female Lower Genital Tract

“…The initial negative HPV-DNA screening result alone would have hampered the timely treatment of this lesion. Although there is presently no screening recommendation for vaginal cancer [38], this case highlights the benefit of the Pap smear in detecting incidental lesions.…”

Importance of Cuff Cytology and Human Papillomavirus Screening, Especially in Patients with Autoimmune Disorders

“…4,5 The risk factors for vaginal cancer include the presence of HPV, other gynecological neoplasias or cancers, smoking, radiation therapy, immunosuppression, and diethylstilbestrol. 9 The history of a previous total hysterectomy performed for CIN II/CIN III is an important risk factor for Vaginal Intra-epithelial Neoplasia (VAIN). While the rate of VAIN was found to be 1.1% in females who underwent hysterectomy for benign conditions, this rate increased to 7.4% in women who underwent hysterectomy for CIN III.…”

“…Follow-up of the patients is performed according to the recent recommendations and international guidelines. 9 The patients with low-grade cytology result (ASCUS/LSIL) or high-risk HPV DNA positivity are recommended vaginal cytology control. The patients with cytology ASC-H are referred for vaginal colposcopy.…”

Vaginal Intraepithelial Neoplasia: Diagnostics, Treatment, and Prevention

“…Во всех исследованиях, направленных на выявление ВПЧ при VAIN и раке влагалища, ВПЧ 16-го типа был наиболее распространенным. ВПЧ обнаружен у 99-100% женщин с low-grade squamous intraepitelial lesions/VAIN I, у 90-96% с high-grade squamous intraepitelial lesions (HSIL)/VAIN II-III и у 64-75% с инвазивным раком влагалища [10][11][12][13][14][15].…”

“…Оценка точности влагалищной цитологии в прогнозировании HSIL/VAIN II-III ограничена несколькими доступными исследованиями. В одном проспективном исследовании 830 женщин после гистерэктомии чувствительность ее была 83% [10,31]. Положительная прогностическая ценность цитологии для HSIL/VAIN II-III, по данным нескольких работ, колеблется от 0 до 14% [10].…”