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. Study Design: 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.

Diagnostic Impacts of Serum CA-125 Levels, Pap Smear Evaluation, and Endometrial Sampling in Women with Endometrial Clear Cell Carcinoma

“…Skaznik-Wikiel et al [12 ]indicated that 25% of the Pap smears in 28 patients with ECCC were abnormal in their study assessing the utility of liquid-based Pap smears in the diagnosis of high-grade endometrial cancers. The incidence of abnormal Pap smears using conventional cytology was 52.3% (n = 11/21) in our study, which is higher compared to previous findings.…”

Endometrial Adenocarcinoma in SurePath™ Cervical Samples: Cytological Features Revisited

“…Poorly differentiated EMCA and papillary serous adenocarcinoma are easier to detect on Pap smears as these are usually associated with high cellularity, with three-dimensional or papillary groups comprised of cells showing nuclear pleomorphism, irregularly distributed granular chromatin and macronucleoli [19,23]. The cytoplasm is usually finely vacuolated and the nuclei are eccentrically located within the cytoplasm.…”

Early stage uterine serous carcinoma: Management updates and genomic advances

“…In a retrospective study of 10 women with high-grade uterine cancer who had preoperative Pap smears, 51.5% had USC, and significantly more patients with USC had abnormal cervical cytology (65.7%) than those with clear cell carcinoma (25%) or grade 3 endometrioid carcinoma (23.8%; p b 0.001) [41]. An abnormal Pap smear was the only presenting clinical finding in a significant number of asymptomatic USC patients (26.9%) compared with 4% of patients with clear cell carcinoma (CC) and grade 3 endometrioid carcinoma (p = 0.005).…”