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  • Title: Postradical vaginal trachelectomy follow-up by isthmic-vaginal smear cytology: a 13-year audit.
    Author: Ghorab Z, Ismiil N, Covens A, Nofech-Mozes S, Saad RS, Dubé V, Khalifa MA.
    Journal: Diagn Cytopathol; 2009 Sep; 37(9):641-6. PubMed ID: 19306425.
    Abstract:
    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.
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