Stokes-Lampard, Helen Jayne (2010)
Ph.D. thesis, University of Birmingham.
Hysterectomy is commonly performed but there is scant evidence concerning appropriate follow-up by vaginal vault cytology testing. This observational, retrospective cohort study, using routinely collected data, linked women’s entire cervical screening histories with their operation details and subsequent vault cytology test results, to establish: Which women are having hysterectomies? What was the indication? Which were followed-up? How did they differ from those who were not? 6,141 women underwent hysterectomy; an incidence of 23/10,000 women/pa. 11.61% had malignancy, 3% had CIN and 82.9% had benign disease. Median age was 48years, women were of greater deprivation and different ethnicity from the background population. Post-operatively 1,016 (16.5%) had vault cytology testing. Those having CIN at total hysterectomy should have vault cytology but only 63% had any, of these less than 10% had it according to protocol. Many factors were associated with having vault cytology (younger, less deprived, non-benign diagnosis and abnormal index cytology) but few clinically meaningful. Only 2.9% of vault cytology tests were abnormal. Efforts to identify and eradicate inappropriate use of vault tests should swiftly lead to savings. Although national guidelines are targeting the right women, it is recommended that all vaginal vault cytology should be undertaken in secondary care hereafter.
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