Cervical cancer screening before hysterectomy in pelvic organ prolapse patients: Is it essential? A case series
Downloads
HIGHLIGHTS
- Higher result of cervical pre-cancer histopathology compared with cervical smear is found in POP patients undergoing vaginal hysterectomy.
- Preoperative biopsy or ultrasound among POP patients undergoing vaginal hysterectomy cannot be a routine procedure.
ABSTRACT
Objective: Pelvic organ prolapse (POP) is caused by a weakening of pelvic floor muscles. The prevalence of unanticipated premalignant and malignant pathologies after hysterectomy is varied from 0.2 to 0.8%. This report to present a case series of POP’s patients undergoing vaginal hysterectomy (VH) with preoperative evaluation of abnormal cervical smear ending with higher result of histopathology.
Case Series: Case 1: A-55-year-old woman, P3A0 was diagnosed as third grade both in uterine prolapse and cystocele. The result of Pap smear revealed atypical glandular cells of undetermined significance (AGUS). Histopathological result after VH was vaginitis and metaplastic chronic cervicitis with atypia to mild dysplasia of endocervical epithelial cell/ low grade squamous intraepithelial lesion (LSIL). Case 2: A-62-year-old woman, P5A0, was diagnosed as third grade of uterine prolapse. The result of Pap smear showed atypical squamous cells of undetermined significance (ASCH). Histopathological result after VH was high grade squamous intraepithelial lesion (HSIL) up to in situ carcinoma with involvement of microinvasive gland and focus.
Conclusion: Since cervical cancer still become the second most common cause of mortality in Indonesia, it is recommended to screen preoperatively for pre-cancerous gynecological lesion and cancer.
Tailor HJ, Bhagat VM, Patel PR, Patel A, Italiya SL. Pap smear findings in uterine prolapse: a coincidence or indicator for impending malignancy. International Journal of Medical Science and Public Health. 2015 Mar 4;5(4):819–819.
Jelovsek JE, Maher C, Barber MD. Pelvic organ prolapse. The Lancet. 2007 Mar 24;369(9566):1027–38.
Merrill RM, Layman AB, Oderda G, Asche C. Risk estimates of hysterectomy and selected conditions commonly treated with hysterectomy. Ann Epidemiol. 2008 Mar;18(3):253–60.
World Health Organization. Cervical cancer [Internet]. 2023 [cited 2023 Nov 29]. Available from: https://www.who.int/news-room/fact-sheets/detail/cervical-cancer
Safaeian M, Solomon D. Cervical Cancer Prevention - Cervical Screening: Science in Evolution. Obstet Gynecol Clin North Am. 2007 Dec;34(4):739–ix.
Guthrie D, Bache W. The infrequency of carcinoma of the cervix with complete procidentia. Ann Surg. 1932 Oct;96(4):796–800.
Aydin S, Bakar RZ, Mammadzade A, Dansuk R. The Incidence of Concomitant Precancerous Lesions in Cases Who Underwent Hysterectomy for Prolapse. 2016;
Grigoriadis T, Valla A, Zacharakis D, Protopapas A, Athanasiou S. Vaginal hysterectomy for uterovaginal prolapse: what is the incidence of concurrent gynecological malignancy? Int Urogynecol J. 2015 Mar;26(3):421–5.
Barakzai S, Koltun-Baker E, Melville SJF, Rangel E, Dahl M, Dancz CE. Rates of unanticipated premalignant and malignant lesions at the time of hysterectomy performed for pelvic organ prolapse in an underscreened population. AJOG Glob Rep. 2023 May;3(2):100217.
Aimjirakul K, Ng JJ, Saraluck A, Wattanayingcharoenchai R, Mangmeesri P, Manonai J. A Retrospective Cohort Study on the Prevalence, Risk Factors, and Improvement of Overactive Bladder Symptoms in Women with Pelvic Organ Prolapse. Int J Womens Health. 2023;15:1039–46.
Ramm O, Gleason JL, Segal S, Antosh DD, Kenton KS. Utility of preoperative endometrial assessment in asymptomatic women undergoing hysterectomy for pelvic floor dysfunction. Int Urogynecol J. 2012 Jul;23(7):913–7.
Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis. 2020 Apr;24(2):102–31.
Elbiaa AAM, Abdelazim IA, Farghali MM, Hussain M, Omu AE. Unexpected premalignant gynecological lesions in women undergoing vaginal hysterectomy for utero-vaginal prolapse. Prz Menopauzalny. 2015 Sep;14(3):188–91.
Suphattanaporn O, Saraluck A, Mononai J, Lekskul N, Chinthakanan O. Prevalence of precancerous gynecological lesions and gynecological cancer in patients undergoing vaginal hysterectomy for pelvic organ prolapse. Ann Med. 2023;55(2):2273428.
Maraqa B, Lataifeh I, Otay L, Badran O, Qutaiba Nouri Y, Issam I, et al. Prevalence of Abnormal Pap Smears: A Descriptive Study from a Cancer Center in a Low-Prevalence Community. Asian Pac J Cancer Prev. 2017 Nov 26;18(11):3117–21.
Koonmee S, Bychkov A, Shuangshoti S, Bhummichitra K, Himakhun W, Karalak A, et al. False-Negative Rate of Papanicolaou Testing: A National Survey from the Thai Society of Cytology. Acta Cytol. 2017;61(6):434–40.
Grimes DR, Corry EMA, Malagón T, O’Riain C, Franco EL, Brennan DJ. Challenges of false positive and negative results in cervical cancer screening [Internet]. medRxiv; 2020 [cited 2023 Dec 10]. p. 2020.03.17.20037440. Available from: https://www.medrxiv.org/content/10.1101/2020.03.17.20037440v1
Melnikow J, Henderson JT, Burda BU, Senger CA, Durbin S, Weyrich MS. Screening for Cervical Cancer With High-Risk Human Papillomavirus Testing: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018 Aug 21;320(7):687–705.
Fleider LA, de los Ángeles Tinnirello M, Gómez Cherey F, García MG, Cardinal LH, García Kamermann F, et al. High sensitivity and specificity rates of cobas® HPV test as a primary screening test for cervical intraepithelial lesions in a real-world setting. PLoS One. 2023 Feb 6;18(2):e0279728.
Macios A, Nowakowski A. False Negative Results in Cervical Cancer Screening—Risks, Reasons and Implications for Clinical Practice and Public Health. Diagnostics (Basel). 2022 Jun 20;12(6):1508.
Schiffman M, Kinney WK, Cheung LC, Gage JC, Fetterman B, Poitras NE, et al. Relative Performance of HPV and Cytology Components of Cotesting in Cervical Screening. J Natl Cancer Inst. 2018 May 1;110(5):501–8.
Nuranna L. See and treat: Cervical cancer prevention strategy in Indonesia with VIA-DoVIA screening and prompt treatment. The Indonesian Journal of Cancer Control. 2022;2(1):32–8.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
1. Copyright of the article is transferred to the journal, by the knowledge of the author, whilst the moral right of the publication belongs to the author.
2. The legal formal aspect of journal publication accessibility refers to Creative Commons Attribution-Non Commercial-Share alike (CC BY-NC-SA), (https://creativecommons.org/licenses/by-nc-sa/4.0/)
3. The articles published in the journal are open access and can be used for non-commercial purposes. Other than the aims mentioned above, the editorial board is not responsible for copyright violation
The manuscript authentic and copyright statement submission can be downloaded ON THIS FORM.
