Endometrial cancer: the potential role of cervical cytology in current surgical staging.
OBJECTIVE
To evaluate cervical cytology, tumor grade from endometrial sampling, and myometrial invasion with the risk of nodal spread in endometrial cancer.


METHODS
Cervical cytology was obtained in 300 patients with endometrial cancer before surgical staging, which included lymphadenectomy. Tumor grade and histology from endometrial sampling were compared with final pathology, and the risk of nodal spread in relation to cervical cytology, tumor grade, and myometrial invasion was assessed using chi(2) and logistic regression analysis.


RESULTS
Endometrial cells on cervical cytology, deep myometrial invasion, and high-grade tumor were associated with 91%, 87%, and 83% of the cases with nodal spread, respectively. In patients with grade 1 tumor on biopsy, final pathology revealed grade 2 in 21%, and grade 3 in 2%. In patients with normal cervical cytology, no nodal metastases occurred with grade 1 tumor on biopsy, and no aortic metastases occurred, regardless of grade. Cervical cytology and tumor grade contributed independently to the likelihood of nodal metastases.


CONCLUSIONS
All patients with endometrial cancer should undergo lymphadenectomy until a reliable system is found to identify those with negligible (less than 1%) risk of nodal spread. The risk of lymph node spread in those with normal cervical cytology is low (2%). Further study of those with normal cervical cytology is needed to determine if lymphadenectomy can be omitted with grade 1 tumor on biopsy, or whether aortic lymphadenectomy is necessary regardless of grade.
DuBeshter
Brent
B
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Strong Memorial Hospital, University of Rochester School of Medicine, 125 Lattimore Road, Rochester, NY 14620, USA. brent_dubeshter@urmc.rochester.edu
Deuel
Colleen
C
Gillis
Shaun
S
Glantz
Christopher
C
Angel
Cynthia
C
Guzick
David
D
D018262:Adenocarcinoma, Clear Cell / Q000473:pathology; D000368:Aged; D001013:Aorta, Thoracic; D018283:Cystadenocarcinoma, Papillary / Q000473:pathology; D016889:Endometrial Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008499:Medical Records; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010388:Pelvis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012509:Sarcoma / Q000473:pathology; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D014626:Vaginal Smears