title: Abnormal cervical cytology in the diagnosis of uterine papillary serous carcinoma: earlier detection of a poor prognostic cancer subtype?
abstract: OBJECTIVE
  Early detection of uterine papillary serous (UPSC), clear cell (CCC), and grade 3 endometrioid carcinomas (G3EC) - all poor prognostic variants of endometrial carcinoma (EC) - is of particular clinical relevance. The study objective was to assess the utility of liquid-based cytology (Pap) in the detection of high-grade EC.
  
  
  METHODS
  A retrospective, two-institution analysis of patients diagnosed with UPSC, CCC, or G3EC with a preoperative Pap from 1999 to 2010 was conducted.
  
  
  RESULTS
  One hundred and one patients were evaluated; 51.5% had UPSC, 27.7% had CCC, and 20.8% had G3EC. Stage I/II disease was found in 69.3% of patients, and 46/101 patients (45.5%) had abnormal Paps. Significantly more patients with UPSC had abnormal Paps (65.7%) than those with CCC (25%) or G3EC (23.8%; p < 0.001). An abnormal Pap was the only presenting clinical finding in a significant number of asymptomatic UPSC patients (26.9%) compared with 4% of patients with CCC and G3EC (p = 0.005). On multivariate analysis, UPSC histology was the only variable associated with an abnormal Pap.
  
  
  CONCLUSIONS
  A high incidence of abnormal cervical cytology was observed in women with high-grade EC, particularly in UPSC patients. Although hypothesis generating, a proportion of asymptomatic UPSC patients had abnormal cytology, signifying that Pap smear screening may help detect the disease before the patient develops symptoms.
authors.affiliation: Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Malgorzata E
authors.initials: ME
authors.lastname: Skaznik-Wikiel
authors.forename: Stefanie M
authors.initials: SM
authors.lastname: Ueda
authors.forename: Heidi E
authors.initials: HE
authors.lastname: Frasure
authors.forename: Peter G
authors.initials: PG
authors.lastname: Rose
authors.forename: Aimee
authors.initials: A
authors.lastname: Fleury
authors.forename: Francis C
authors.initials: FC
authors.lastname: Grumbine
authors.forename: Amanda Nickles
authors.initials: AN
authors.lastname: Fader
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002584:Cervix Uteri / Q000002:abnormalities* / Q000473:pathology*; D003536:Cystadenocarcinoma / Q000175:diagnosis* / Q000473:pathology*; D003584:Cytological Techniques / Q000379:methods*; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D011379:Prognosis; D014626:Vaginal Smears