Impact of positive cytology in uterine serous carcinoma: A reassessment

Corey, Logan; Fucinari, Juliana; Elshaikh, Mohamed A.; Schultz, Daniel; Mussallam, Rami; Zaiem, Feras; Daaboul, Fayez; Fehmi, Omar; Dyson, Greg; Ruterbusch, Julie J.; Morris, Robert T.; Cote, M.L.; Ali-Fehmi, Rouba; Bandyopadhyay, Sudeshna

doi:10.1016/j.gore.2021.100830

Cited by 8 publications

(11 citation statements)

References 39 publications

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“…Multivariate analysis in our study also suggested that malignant peritoneal cytology was an independent risk factor for both PFS and OS. These findings are consistent with two previous reports focusing on non-endometrioid EC [ 11 , 14 ]. Matsuo et al reported that the mortality risk is nearly tripled (HR 2.59) with a 5-year survival rate decrease of 19.4% in stage I non-endometrioid EC patients with malignant peritoneal cytology [ 11 ].…”

Section: Discussionsupporting

confidence: 94%

“…One study reported that diagnosis at an older age (>78 years old), serous histology, and larger tumor size were associated with increased risks of malignant peritoneal cytology [ 11 ]. Other studies, however, have failed to find an association between clinical-pathological factors and malignant peritoneal cytology [ 12 , 14 ]. A meta-analysis demonstrated that hysteroscopy is associated with a higher rate of positive peritoneal cytology when compared with no hysteroscopy, but this phenomenon is not identified in early-stage EC [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

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Prognostic Value of Peritoneal Cytology in Stage I Serous and Clear Cell Carcinoma of the Endometrium

Yang

Cao

et al. 2023

JCM

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(1) Background: To investigate the relation between malignant peritoneal cytology and survival outcomes in patients who underwent primary staging surgery for stage I uterine serous (USC) or clear cell carcinoma (UCCC). (2) Methods: In this retrospective analysis, patients with stage I USC or UCCC who underwent staging surgery between 2010 and 2020 at the Peking Union Medical College Hospital were identified and reviewed. (3) Results: A total of 101 patients were included, and 11 patients had malignant cytology (10.9%). The median follow-up time was 44 months (range 6–120) with a total of 11 (10.9%) recurrences. Patients with malignant cytology had a higher likelihood of peritoneal recurrence and a shorter time to relapse (13 vs. 38 months, p = 0.022), as compared to patients with negative cytology. In univariate analysis, malignant cytology and serous histology had worse progression-free survival (PFS) and overall survival (OS) (all, p < 0.05). In sensitive analysis, the detrimental effects of malignant cytology on survival were more prominent in patients over 60 years old, those with serous histology, stage IB disease, and those who received hysteroscopy as a diagnostic test. (4) Conclusions: Stage I USC or UCCC patients with malignant peritoneal cytology had a higher recurrence and inferior survival.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Peritoneal Cytology in Stage I Serous and Clear Cell Carcinoma of the Endometrium

Yang

Cao

et al. 2023

JCM

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“…Another recent study out of Michigan examined a cohort of 148 women with USC and found that 22% of the cohort had positive washings. The presence of malignant cytology in this study was significantly associated with recurrence and overall survival (HR 2.09, 95% CI [1.19-3.68]) [ 17 ]. A large Surveillance, Epidemiology, and End Results database study of over 14,000 patients with uterine cancer identified that five-year disease-specific survival for women with negative cytology was significantly better than those with positive cytology (95.1% vs 80.8% in endometrioid adenocarcinoma and 78.0% vs 50.4% in clear cell or serous carcinoma) [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a Patient With Non-Myoinvasive Uterine Serous Carcinoma Confined to a Polyp and Positive Peritoneal Washings With Somatic ARHGAP35 and KRAS Mutations

Silverwood¹,

Lagstein²,

Risinger³

et al. 2022

Cureus

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Currently, the application of peritoneal washings as a diagnostic tool for endometrial cancer staging is not well defined. The case described aims to highlight the current ambiguity surrounding the use of peritoneal washings in clinical practice.A 69-year-old G3P3003 presented to her gynecologist with complaints of new-onset heavy vaginal bleeding. The patient sought an endometrial biopsy, which suggested serous endometrial intraepithelial carcinoma (EIC) focally suspicious for invasive carcinoma, with the involvement of polyps. Based on these results, a robotic-assisted total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, bilateral sentinel lymph node dissection, and omentectomy were performed. Results from her final pathology exhibited a stage IA uterine serous carcinoma (USC) involving a polyp (4.2 cm in greatest dimension) with no myometrial or lymphovascular invasion, but washings were positive for adenocarcinoma. Based on her family history of malignancy, the patient underwent germline panel testing. The patient's somatic tumor testing demonstrated proficient DNA mismatch repair status, microsatellite stability, low tumor mutational burden (4 mut/Mb), low loss of heterozygosity (9%), amplification of the ERBB2 (HER2/neu) gene by both immunohistochemistry (3+, 20% positive) and fluorescence in-situ hybridization. Her tumor also had weakly positive estrogen receptor expression (1+, 10% positive); furthermore, some pathogenic variants in KRAS (c.37G>T), PIK3CA (c.263G>A), and TP53 (c.743G>A) were identified. Given the incongruent findings found with the positive peritoneal washing and negative lymph node involvement in addition to molecular testing, management for this patient was unclear.Ultimately, this case highlights a number of advances within the field of gynecological oncology but also emphasizes the persistent ambiguity and incongruency in the management of patients with early-stage high-risk histologies. Moving forward it will become increasingly important to be able to develop a more standardized process to assess how these diagnostic tools should inform prognosis and treatment plans.

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“…In addition, a study based on the Surveillance, Epidemiology, and End Results database showed that positive peritoneal washings predict decreased survival 6 . Focusing on the histological type, positive cytology was reported to be a prognostic factor in serous uterine cancer 16 …”

Section: Introductionsmentioning

confidence: 99%

Significance of positive peritoneal cytology for recurrence and survival in patients with endometrial cancer

Ueno

Toyoshima

Shigemi

et al. 2022

J of Obstet and Gynaecol

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Aim: This study aims to examine the association between malignant peritoneal cytology and prognosis in women with endometrial cancer. Methods: We retrospectively analyzed the records of patients with endometrial cancer who underwent surgery with intraoperative peritoneal cytology at our hospital between January 1988 and December 2012. All results were reclassified according to the 2009 International Federation of Gynecology and Obstetrics (FIGO) system, and the relation between intraoperative peritoneal cytology results and recurrence and prognosis was examined. Results: Of the 908 patients analyzed, 205 (22.6%) had positive peritoneal cytology. Patients with positive peritoneal cytology had significantly lower rates of recurrence-free survival (RFS) and overall survival (OS) than those in the negative cytology group (both p < 0.001). Subgroup analysis of patients with FIGO stage I/II showed significantly lower RFS in the positive-cytology group (p = 0.005), but there was no significant difference in OS (p = 0.637). In the patients with FIGO stage III/IV or patients classified as "high risk," the RFS and OS were significantly lower in the positive-cytology group (both p < 0.001). Cox regression analysis identified positive peritoneal cytology as a significant predictor of recurrence in patients with FIGO stage I/II disease. Conclusions: Patients with positive peritoneal cytology for endometrial cancer have a high risk of recurrence, regardless of histopathologic type or FIGO stage. Peritoneal cytology has already been removed from the 2009 FIGO classification of endometrial cancer, but it may deserve reconsideration.

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Impact of positive cytology in uterine serous carcinoma: A reassessment

Cited by 8 publications

References 39 publications

Prognostic Value of Peritoneal Cytology in Stage I Serous and Clear Cell Carcinoma of the Endometrium

Prognostic Value of Peritoneal Cytology in Stage I Serous and Clear Cell Carcinoma of the Endometrium

Evaluation of a Patient With Non-Myoinvasive Uterine Serous Carcinoma Confined to a Polyp and Positive Peritoneal Washings With Somatic ARHGAP35 and KRAS Mutations

Significance of positive peritoneal cytology for recurrence and survival in patients with endometrial cancer

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