Regular follow-up with cervical cytology is of questionable value following surgical treatment of microinvasive cervical cancer

• Published in: European journal of obstetrics & gynecology and reproductive biology 2024-05, Vol.296, p.307-310
• Main Authors: Ashmore, Ayisha A., Abdul, Summi, Phillips, Andrew, Bali, Anish, Tamizian, Onnig, Asher, Viren
• Format: Article
• Language: English
• Subjects: Cervical neoplasms; Cytodiagnosis; Cytology; Female; Follow-Up Studies; Humans; Neoplasm Recurrence, Local; Recurrence; Retrospective Studies; Uterine Cervical Dysplasia - diagnosis; Uterine Cervical Neoplasms - pathology; Vaginal Smears
• ISSN: 0301-2115; 1872-7654; 1872-7654
• DOI: 10.1016/j.ejogrb.2024.03.020

•The duration of follow-up for conservatively treated microinvasive surgical cancer is varied.•98 patients with microinvasive cervical cancer who underwent conservative surgery were follow-up with 510 smears over approximately 11 years.•There were no recurrent cancers detected and only 2 smears showing high grade dyskaryosis.•Reducing the intensity of follow-up should be considered. To assess the follow-up smears and their outcomes of patients with conservatively managed early-stage cervical cancer as per UK guidelines within our service. To evaluate whether intensive follow-up can detect pre-cancer early compared to the standard 3 yearly follow-up. Retrospective review. All patients treated for early stage (stage 1A1 and 1A2) with cervical cancer from 01/2002 to 01/2020 at University Hospitals of Derby and Burton were included. Patients who had initial hysterectomy were excluded from our analysis. Review conducted using electronic patient records for treatment, histology, and follow-up smears. Number of abnormal follow-up smears and number of recurrent cervical cancers were considered the main outcome measures. 98 cases were identified. 81 (82.65 %) were stage 1A1 and 17 (17.35 %) were stage 1A2. 74 (75.51 %) patients had squamous histology and 24 (24.49 %) had adenocarcinomas. Median follow-up was 11.08 years (4043 days). 510 follow-up smears were performed, of which 33 (6.47 %) were abnormal. 5 of these abnormal smears showed low grade dyskaryosis (0.98 %) and 2 smears showed high grade dyskaryosis (0.39 %). The positive predictive value of follow-up smears to detect pre-cancerous changes was 5.71 %. There were no recurrent cancers detected. Microinvasive cervical cancer is effectively managed with conservative surgery. There were no recurrent cancers detected in our cohort during follow-up and there were only 2 high grade dyskaryoses detected (n = 2/510, 0.39 %). We therefore believe that reducing the intensity of follow up of these patients should be considered.