title: Prognostic significance of malignant cervical cytology in patients with endometrial cancer.
abstract: OBJECTIVE
  To determine the prognostic importance of malignant cervical cytology before surgical stating in patients with endometrial cancer.
  
  
  METHODS
  Between September 1987 and August 1993, 164 patients with endometrial cancer had preoperative cervical cytology examined before surgical staging, which included pelvic and para-aortic lymphadenectomy.
  
  
  RESULTS
  Ninety-four patients (57.3%) had normal cervical cytology, 21 (12.8%) had atypical cytology suspicious for malignancy, and 49 (29.9%) had malignant cytology on preoperative cervical cytology. Statistically significant associations were found between cervical cytology and histopathology (P = .017), tumor grade (P = .001), cervical metastases (P < .001), surgical stage (P = .035), pelvic lymph node metastases (P = .016), and para-aortic lymph node metastases (P = .006). Patients with malignant cytology were more likely to have non-endometrioid histology, poorly differentiated malignancies, higher surgical stage, and cervical, pelvic lymph node, and para-aortic lymph node metastases. Patients with malignant cervical cytology had a 3.5 times higher prevalence of pelvic lymph node metastases and a five times higher prevalence of para-aortic lymph node metastases than patients with normal cytology. No association was found between preoperative cervical cytology and the depth of myometrial invasion, adnexal metastases, omental metastases, or malignant pelvic peritoneal cytology.
  
  
  CONCLUSIONS
  Patients with endometrial cancer and malignant preoperative cervical cytology are at marked risk for extrauterine metastases, including pelvic and para-aortic lymph node metastases. Such patients should be considered for primary surgical staging, including pelvic and para-aortic lymphadenectomy.
authors.affiliation: Department of Obstetrics and Gynecology, Marshfield Clinic, Wisconsin.
authors.forename: D M
authors.initials: DM
authors.lastname: Larson
authors.forename: K K
authors.initials: KK
authors.lastname: Johnson
authors.forename: C N
authors.initials: CN
authors.lastname: Reyes
authors.forename: S K
authors.initials: SK
authors.lastname: Broste
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology* / Q000556:secondary; D000368:Aged; D016889:Endometrial Neoplasms / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D012307:Risk Factors; D014626:Vaginal Smears