Original Research

Prevalance of abnormal vault cytology after hysterectomy for cervical intraepithelial neoplasia, Pietermaritzburg

Sanele S. Mbuyisa, Thandekile L. Khumalo, Bongumusa S. Makhathini, Jagidesa Moodley
South African Family Practice | Vol 64, No 1 : Part 2| a5457 | DOI: https://doi.org/10.4102/safp.v64i1.5457 | © 2022 Sanele Sidwell Mbuyisa | This work is licensed under CC Attribution 4.0
Submitted: 22 November 2021 | Published: 31 March 2022

About the author(s)

Sanele S. Mbuyisa, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa
Thandekile L. Khumalo, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Edendale Regional Hospital, University of KwaZulu-Natal, Durban, South Africa
Bongumusa S. Makhathini, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa
Jagidesa Moodley, Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa

Abstract

Background: A simple hysterectomy is considered the definitive treatment modality for cervical intraepithelial neoplasia (CIN). However, it is associated with recurrence of vaginal intraepithelial neoplasia (VAIN) of up to 7.4%. We sought to determine recurrence rates of VAIN, in women living with HIV (WLWH) and non-infected women.

Methods: This was a descriptive retrospective review of patients who received a simple hysterectomy for CIN between January 2015 and December 2017 in Pietermaritzburg.

Results: Fifty-eight files were reviewed. Forty-two (72.4%) WLWH were seen; amongst those, 76.2% were virally suppressed. Abnormal vault cytology was only seen in patients with CIN grades 2 and 3. The recurrence rates for high-grade squamous intraepithelial lesion (HSIL) were 6.1% and 5.0% at 6 and 12 months, respectively. Human immunodeficiency virus co-infection was associated with 26.2% versus 13.3% of abnormal vault cytology compared to the HIV-negative counterparts (p = 0.164). Virologically suppressed patients had more abnormal cytology (28.1% vs. 0%) compared to the unsuppressed patients. There was a 17.2% and 65.5% loss- to follow-up rates at 6 and 12 months, respectively. Recurrence of premalignant lesions was noted amongst those who had the abdominal approach.

Conclusion: The recurrence rates were comparable to the previous literature. A 6-month cytology follow-up showed no added benefit. Human immunodeficiency virus co-infection didn’t show a statistical significance on the recurrence rates; however, more structured studies are required to address this. Primary health care-based post operative surveillance can be a solution to address high loss to follow-up.


Keywords

cervical intraepithelial neoplasia; recurrence rates; simple hysterectomy; vaginal intraepithelial neoplasia; vain

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