Upstaging based solely on positive peritoneal washing does not affect outcome in endometrial cancer

Abstract

Surgical staging of endometrial carcinoma includes the collection of peritoneal washings in the abdomen and pelvis. A positive finding upstages patients to International Federation of Gynecology and Obstetrics stage IIIA. However, the prognostic significance of such an upstaging, and thus the justification for the routine performance of this procedure, is unclear. This 5-year retrospective study was conducted to determine the frequency and prognostic significance of upstaging of endometrial carcinoma based solely on positive washings. The cohort for the study was collected by review of pathology reports of all washings that were performed prior to hysterectomies for suspected endometrial carcinomas over a 5-year period (01/1995-12/ 1999). Cases with positive cytology were selected if there was no grossly apparent intraperitoneal disease, no histologic evidence of extra-uterine tumor and the cases would otherwise have been considered stage I or II (case group). An age-matched control group was selected of stage I and II patients with the same histologic subtypes and negative washings (n ¼ 19). Of 220 endometrial carcinomas, peritoneal washing cytology was abnormal in 19 (8.6%) and was solely responsible for upstaging only 10 patients (4.5% of all cases, eightendometrioid, one-serous, one-mixed; nine stage IA or IB and one stage IIB). Adjuvant therapy was administered in 90% of the case group and 74% of the control group. After a median follow-up of 51 months (case group) and 63 months (control group), we found only a single patient with progression of disease (recurrence, metastases or death) in the control group. It is concluded that abnormal cytology without other evidence of extrauterine disease leads to upstaging of a minority of endometrial carcinoma patients (4.5%), but does not appear to affect their overall outcome. Although this is a small single site study, it raises questions about the value of this procedure in patients with endometrial cancer.

Does the revised International Federation of Gynecology and Obstetrics staging system for endometrial cancer lead to increased discrimination in patient outcomes?

“…[4][5][6] Rather, it is more likely to correlate with other adverse prognostic features. [7][8][9][10][11] Others have suggested that the presence of positive cytology in patients with low-stage disease represents transient cells without the capability of metastatic growth or intraperitoneal spread that, instead, result from surgical manipulation or previous hysteroscopy. 12,13 Obermair et al demonstrated that patients designated as stage IIIA by positive washings alone had similarly favorable outcomes with or without adjuvant treatment.…”

Recent Developments in Surgical Pathology of the Uterine Corpus

“…The significance of positive peritoneal washings for disease recurrence and survival is uncertain, but most studies indicate no impact on clinical outcome. 93 The 2009 FIGO staging system no longer incorporates the results of peritoneal washings in endometrial carcinoma staging. 94 However, results should still be reported.…”

Influence of positive peritoneal cytology on prognostic factors and survival in early-stage endometrial cancer: a systematic review and meta-analysis

“…Although this finding suggests that the prognostic significance of PPC depends on the presence of other risk factors (7,8), other studies have reported that PPC is an independent factor for survival in patients with surgically staged EEC (3,5,9,10). Additional studies have addressed the prognostic significance of PPC in terms of its relation to other factors such as grade, MI and LVSI, and the results are conflicting (4)(5)(6)(7)(11)(12)(13)(14). A large-scale study using the Surveillance, Epidemiology and End Results (SEER) database found that the incidence of PPC increased in surgically staged EEC with highrisk factors such as Grade 3, clear cell or serous carcinoma and carcinosarcoma (9).…”