Characteristics and prognostic significance of incidentally detected cancer cells in uterine specimens of patients with pelvic high‐grade serous carcinoma

Abstract

Objective Cases of pelvic high‐grade serous carcinoma (HGSC) with incidentally detected cancer cells (ICCs) in endometrial and/or cervicovaginal cytology have been reported. This study aimed to clarify the incidence and characteristics of pelvic HGSC with ICCs and to determine whether ICCs have a negative prognostic impact. Methods Patients with ovarian/tubal/peritoneal HGSC who underwent pre‐treatment uterine (endometrial/cervicovaginal) cytology or biopsy between January 2007 and May 2017 were included. We reviewed the frequencies of ICCs and compared the clinicopathological features and survival outcome between the ICC‐positive and ICC‐negative groups. Results Of the 160 patients evaluated, 69 (43.2%) had positive ICCs in at least one uterine specimen. There were no significant differences in clinicopathological characteristics, such as age, FIGO stage, serum CA125 level, ascites, and tubal lesion, between the two groups. Moreover, ICCs had no significant survival impact on progression‐free survival or overall survival. Conclusion Our study showed a high rate of pelvic HGSC with ICCs in pre‐treatment uterine specimens. The ICCs per se had no negative impact on survival outcomes of pelvic HGSC. Furthermore, uterine biopsy and cytology can be useful and less‐invasive methods to obtain tubo‐ovarian/peritoneal cancer cells before treatment.

Positive rate of malignant cells in endometrial cytology samples of ovarian cancer, fallopian tube cancer, and primary peritoneal cancer patients: A systematic review and meta-analysis

“…Our literature review indicated that the positive rates of malignant cells in ascites cytology of ovarian cancer, fallopian tube cancer, and primary peritoneal cancer patients ranged from 18.1% to 85%, and 6.1% to 25% in cervicovaginal cytology [ Table 2 ]. [ 26 27 28 29 30 31 32 40 ]…”

“…Fifty-seven case reports, case series, and two abstracts were excluded. Finally, seven retrospective studies[ 26 27 28 29 30 31 32 ] including 975 patients were identified [ Figure 1 ].…”

“…All of the included studies showed a low risk of bias in terms of “aim”, “data selection”, “endpoints”, “endpoint assessment”, and “loss to follow up less than 5%”. Five studies[ 27 29 30 31 32 ] didn’t report if the patients were selected continuously or not, and thus, they were considered “unclear risk” [ Figure 2 ].…”

“…The test of difference between subgroups showed a significant difference ( P < 0.001). The specific sampling tools were listed in Table 1 , two of the studies didn’t report the staining methods, and[ 28 30 ] all of the other studies used Papanicolaou stain.…”

Molecular Pathology of Human Papilloma Virus-Negative Cervical Cancers

“…However, Jenkins et al recently reported that cervical serous carcinoma ( n = 6, HPV-negative) harbors mutations in TP53 (50%), KRAS (33%), PIK3CA (17%), and PTEN (17%) [ 44 ]. The possibility of drop metastasis in endometrial serous and adnexal HGSC should always be considered since tumor cells are detected in ~40% of uterine specimens in advanced HGSC [ 122 ]. Therefore, a diagnosis of cervical serous carcinoma should only be made after thorough and extensive sampling of the endometrium and fallopian tubes using the sectioning of the fimbriated end of the fallopian tube (SEE-FIM) technique.…”