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Cytologic screening after hysterectomy for benign disease

  • Joanne T. Piscitelli
    Correspondence
    Reprint requests: Joanne T. Piscitelli, MD, Box 3456, Duke University Medical Center, Durham, NC 27710.
    Affiliations
    Division of General Obstetrics-Gynecology, Duke University, Durham Department of Veterans Affairs Medical Center, Durham, North Carolina, USA
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  • Lori A. Bastian
    Affiliations
    Comprehensive Women Veterans Health Center, Durham Department of Veterans Affairs Medical Center, Durham, North Carolina, USA

    Center for Health Services Research in Primary Care, Durham Department of Veterans Affairs Medical Center, Durham, North Carolina, USA
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  • Andrea Wilkes
    Affiliations
    Comprehensive Women Veterans Health Center, Durham Department of Veterans Affairs Medical Center, Durham, North Carolina, USA
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  • David L. Simel
    Affiliations
    Comprehensive Women Veterans Health Center, Durham Department of Veterans Affairs Medical Center, Durham, North Carolina, USA

    Center for Health Services Research in Primary Care, Durham Department of Veterans Affairs Medical Center, Durham, North Carolina, USA
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      Abstract

      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.

      Keywords

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