Contribution of cervical cytology in the diagnostic work‐up of patients with endometrial cancer |
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Authors: | L. C. M. Amkreutz J. M. A. Pijnenborg D. W. L. Joosten H. J. M. M. Mertens S. M. J. Van Kuijk M. J. A. Engelen M. Bergmans W. E. Nolting R. F. P. M. Kruitwagen |
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Affiliation: | 1. Department of Obstetrics and Gynecology, Zuyderland Medical Centre, Sittard‐Geleen and Heerlen, The Netherlands;2. Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands;3. KEMTA‐Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Limburg, The Netherlands;4. Department of Obstetrics and Gynecology, Sint Laurentius Hospital, Roermond, The Netherlands;5. Department of Obstetrics and Gynecology, SJG Weert, Weert, The Netherlands;6. Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands;7. GROW‐School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands |
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Abstract: | Introduction Abnormal cervical cytology in patients with endometrial cancer (EC) has been associated with poor outcome. The aim of this study was to evaluate whether cervical cytology could contribute to an improved preoperative identification of high‐grade EC (serous, clear cell, carcinosarcoma, high‐grade endometrioid EC) in final histology. Methods A retrospective cohort study was performed in five hospitals in the Netherlands. A total of 554 patients with EC that underwent primary surgical treatment between 2002 and 2010 were included. Primary outcome was defined as the contribution of abnormal cervical cytology in the preoperative identification of high‐grade EC. As secondary outcome, recurrence‐free survival (RFS) and disease‐specific survival were determined based on preoperative cervical cytology, and compared to the currently established risk factors: myometrial invasion, high‐grade and lymph vascular space invasion. Results Abnormal cervical cytology was present in 45.1%. For patients with preoperative inconclusive and high‐grade histology, the presence of abnormal cervical cytology contributed to an improved identification of high‐grade EC in final histology (odds ratio [OR] 6.40 [95% confidence interval {CI}: 1.92‐21.26]; OR 2.86 [95% CI: 1.14‐7.14]), respectively. Patients with abnormal cervical cytology had a significant worse 5‐year median RFS. Abnormal cervical cytology was independently related to RFS (hazard ratio 1.67 [95% CI: 1.04‐2.68]) and disease‐specific survival (hazard ratio 3.15 [95% CI: 1.74‐5.71]). Conclusions Abnormal cytology contributes to the preoperative identification of patients with high‐grade EC, and is associated with compromised outcome. Future studies are warranted to determine whether cervical cytology could be incorporated into preoperative prediction models for lymph node metastasis. |
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Keywords: | cervical cytology diagnosis endometrial neoplasms Papanicolaou smear preoperative |
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