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Postradical vaginal trachelectomy follow‐up by isthmic‐vaginal smear cytology: A 13‐year audit

Radical trachelectomy is a fertility preserving alternative for early cervical cancer patients. This audit assesses the role of isthmic‐vaginal smear in postoperative follow‐up. A total of 94 patients were identified generating 913 smears. The final surgical margin was at the lower uterine segment in 37 cases (39.4%) and significantly correlated with the presence of lower uterine segment endometrial cells (LUSEC) in smears (P = 0.035). The most common abnormal diagnoses in the presence of LUSEC were ASC‐US and AGUS seen in 14.2% and 11.9% of positive smears, respectively. The most common follow‐up pattern was initial positive smears, which converted to negative (45.7% of patients), showing that reactive changes are another potential overcall pitfall. The only 2 central recurrences were successfully diagnosed by smears. This study summarizes our experience, emphasizing the role of isthmic‐vaginal smears for early detection of central recurrence and highlighting the role of LUSEC and reactive changes as potential overcall pitfalls. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.