Cervical Cytology in Serous and Endometrioid Endometrial Cancer

Abstract

The aim of this study was to determine the frequency of abnormal cervical cytology in preoperative cervical cytology of patients diagnosed with uterine papillary serous carcinoma (UPSC) and endometrioid endometrial carcinoma (EEC). In addition, associations between abnormal cervical cytology and clinicopathologic factors were evaluated. In this multicentre study, EEC patients diagnosed at two hospitals from 1999 to 2009 and UPSC patients diagnosed at five hospitals from 1992 to 2009, were included. Revision of the histologic slides was performed systematically and independently by 3 gynecopathologists. Cervical cytology within six months before histopathologic diagnosis of endometrial carcinoma was available for 267 EEC and 80 UPSC patients. Cervical cytology with atypical, malignant, or normal endometrial cells in postmenopausal women was considered as abnormal cytology, specific for endometrial pathology. Abnormal cervical cytology was found in 87.5% of UPSC patients, compared with 37.8% in EEC patients. In UPSC, abnormal cytology was associated with extrauterine spread of disease (P=0.043). In EEC, abnormal cytology was associated with cervical involvement (P=0.034). In both EEC and UPSC patients, abnormal cervical cytology was not associated with survival. In conclusion, abnormal cervical cytology was more frequently found in UPSC patients. It was associated with extrauterine disease in UPSC patients, and with cervical involvement in EEC patients. More prospective research should be performed to assess the true clinical value of preoperative cervical cytology in endometrial cancer patients.

Contribution of cervical cytology in the diagnostic work‐up of patients with endometrial cancer

“…In the subset of serous carcinomas, we found an equally high percentage of abnormal cervical cytology of 85.4% (41/48). The association of abnormal cervical cytology with advanced FIGO stage in our study was also demonstrated by Roelofsen et al, who observed a correlation of abnormal cervical cytology with cervical stromal invasion in endometrioid‐type endometrial carcinoma, and advanced stage in serous endometrial carcinoma. Also in our series there was a significant relation with abnormal cervical cytology and cervical stromal involvement.…”

“…Also in our series there was a significant relation with abnormal cervical cytology and cervical stromal involvement. However, in contrast to Roelofsen et al, 22 we also found a correlation of abnormal cervical cytology with both disease‐specific and overall survival . This might be explained by the differences in study cohorts, since in our cohort all histological types were included, whereas Roelofsen et al only included patients with endometrioid and serous‐type endometrial carcinoma.…”

“…The overall incidence of abnormal cervical cytology in our study (45.1%) is comparable to numbers reported in the literature (31%‐50%) . In patients with serous endometrial carcinoma, abnormal cervical cytology is reported in up to 65.7%‐87.5% of patients, and may even be considered as a prognostic marker for non‐endometrioid histology . In our cohort, 60.7% of patients with high‐grade tumours presented with abnormal cervical cytology.…”

“…Moreover, there was a difference in the criteria for abnormal cytology. We defined abnormal cytology more strictly as the presence of atypical glandular cells or EC cells, whereas Roelofsen et al included the presence of endometrial cells into abnormal cervical cytology . Categorization of the presence of endometrial cells into normal cervical cytology is supported by recent data of Izadi‐Mood et al, 25 who demonstrated in a series of 199 cases that the presence of endometrial cells in cervical cytology tests of women older than 40 years was not associated with significant endometrial lesions …”

Adjuvant treatment, tumour recurrence and the survival rate of uterine serous carcinomas: a single-institution review of 62 women

“…Roelofsen et al showed that abnormal endometrial cells on cytology may be found more commonly in patients with USC, than in patients with endometrioid carcinoma, where this is rare. 23 In accordance with other authors, LVSI, the depth of myometrial invasion and tumour size were not significantly associated with a poor prognosis in USC. 24,25 In our study, more than half of the USCs coexisted with at least one other subtype of uterine cancer (endometrioid, clear cell and mucinous).…”