Cytology Detects Proportion of Cervical Cancer Recurrence

ASC-US, LSIL without visible lesions can be followed without colposcopy unless abnormalities persist

THURSDAY, Sept. 8 (HealthDay News) -- Liquid-based cytology detects cervical cancer recurrence in about one-third of patients treated for cervical cancer; and, in the absence of any visible lesions, colposcopy is not indicated for follow-up of patients with atypical squamous cells of uncertain significance (ASC-US) or low-grade squamous intraepithelial lesions (LSIL), unless abnormalities persist, according to a study published in the September issue of Obstetrics & Gynecology.

B.J. Rimel, M.D., from the Washington University School of Medicine in St. Louis, and colleagues evaluated the utility of liquid-based cytology in detecting recurrent cervical cancer. A total of 929 women treated for cervical cancer between 2000 and 2009 having at least single posttreatment liquid-based cytology or colposcopy were included. A cervicovaginal cytologic diagnosis was made using Pap tests.

The investigators identified 4,167 cytology results from the participants. Abnormal results were observed in 626 Pap tests from 312 women (34 percent), including 296 ASC-US, 179 LSIL, 59 atypical squamous cells, 55 high-grade squamous intraepithelial lesions, 14 atypical glandular cells, and 23 favor neoplasia. Abnormal Pap-test results led to 201 colposcopies in 135 women. Cervical intraepithelial neoplasia (CIN) 2 or worse, CIN 3, and cancer were found in 45, 25, and 12 women, respectively. Of the 475 women with ASC-US or LSIL only five had CIN 3. A total of 147 women had cancer recurrence with 12 detected by Pap test. Colposcopy did not detect recurrence or CIN 3 for cytology less than high-grade squamous intraepithelial lesions without a visible lesion. Stratification by stage and institution identified a significantly higher risk of abnormal Pap results in patients treated with radiation.

"A third of cervical cancer survivors will have abnormal cytology during follow-up, but in the absence of a visible lesion, those with ASC-US or LSIL can be followed without colposcopy unless abnormalities persist," the authors write.

One of the study authors disclosed financial relationships with Roche Molecular Systems and Qiagen.

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