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Background <p>On January&#xa0;1, 2020, the previous cervical cancer screening method of annual Pap smears was revolutionized in Germany. Co-testing was introduced for women aged&#xa0;35 and older, consisting of a&#xa0;human papillomaviruses (HPV) test and cytological smear according to Papanicolaou. Co-testing for patients after hysterectomy without residual cervical tissue is limited; however, it was made available to patients without cervical tissue in Lower Saxony. This led to an increase in appointments at the dysplasia clinic due to HPV positivity with normal cytology.</p> Objective <p>Does co-testing improve the detection of therapeutically relevant vaginal dysplasia/carcinoma in women who have undergone hysterectomy?</p> Materials and methods <p>For the retrospective data analysis, all patients of the dysplasia unit at the University Medical Center Oldenburg who presented between January&#xa0;1, 2016, and December&#xa0;31, 2023, due to an abnormal cytological smear or positive HPV test of the vagina without cervical tissue were included. The frequencies of vaginal dysplasia/carcinoma at initial presentation were evaluated (group&#xa0;A: 2016–2019 vs. group&#xa0;B: 2020–2023).</p> Results <p>A&#xa0;total of 109 initial presentations were included. In group&#xa0;A, 29/30 initial presentations were due to abnormal cytology, while in group&#xa0;B, 49/79 initial presentations were due to HPV positivity with normal cytology. Vaginal dysplasia was detected in only 7/49&#xa0;patients. Significantly fewer dysplasias/carcinomas were found in group&#xa0;B (29.1% vs. 76.7%, <i>p</i> &lt; 0.001).</p> Conclusion <p>In cases where HPV positivity alone was the reason for referral, only mild to moderate dysplasia/carcinoma was found, but no severe cases. Consequently, co-testing does not appear to be useful in women who have undergone hysterectomy and have no cervical tissue. It should only be reserved for high-risk patients with a&#xa0;history of dysplasia/cancer.</p>

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Vaginale Dysplasien nach Hysterektomie – vor und nach Einführung der Ko-Testung

  • 期刊论文

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  • 发表日期：

    2026年8月3日

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  • Meike Schild-Suhren,
  • Paula Winkler,
  • Eduard Malik,
  • Dörte W. Lüdders

摘要

Background

On January 1, 2020, the previous cervical cancer screening method of annual Pap smears was revolutionized in Germany. Co-testing was introduced for women aged 35 and older, consisting of a human papillomaviruses (HPV) test and cytological smear according to Papanicolaou. Co-testing for patients after hysterectomy without residual cervical tissue is limited; however, it was made available to patients without cervical tissue in Lower Saxony. This led to an increase in appointments at the dysplasia clinic due to HPV positivity with normal cytology.

Objective

Does co-testing improve the detection of therapeutically relevant vaginal dysplasia/carcinoma in women who have undergone hysterectomy?

Materials and methods

For the retrospective data analysis, all patients of the dysplasia unit at the University Medical Center Oldenburg who presented between January 1, 2016, and December 31, 2023, due to an abnormal cytological smear or positive HPV test of the vagina without cervical tissue were included. The frequencies of vaginal dysplasia/carcinoma at initial presentation were evaluated (group A: 2016–2019 vs. group B: 2020–2023).

Results

A total of 109 initial presentations were included. In group A, 29/30 initial presentations were due to abnormal cytology, while in group B, 49/79 initial presentations were due to HPV positivity with normal cytology. Vaginal dysplasia was detected in only 7/49 patients. Significantly fewer dysplasias/carcinomas were found in group B (29.1% vs. 76.7%, p < 0.001).

Conclusion

In cases where HPV positivity alone was the reason for referral, only mild to moderate dysplasia/carcinoma was found, but no severe cases. Consequently, co-testing does not appear to be useful in women who have undergone hysterectomy and have no cervical tissue. It should only be reserved for high-risk patients with a history of dysplasia/cancer.