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

Abstract

Background: Endometrial clear cell carcinoma (ECCC) is a rare variant of endometrial cancer with an unfavorable prognosis. The aim of this study was to determine the relationships, if any, between preoperative serum cancer antigen 125 (CA-125) levels, the last Papanicolaou (Pap) smear, the results of endometrial biopsy and tumor histology, and disease-stage according to permanent histopathology. Materials and Methods: The data of 26 women with ECCC were collected from their medical records to compare demographics, preoperative serum CA-125 levels, Pap test results, histological diagnosis of the endometrial biopsy, and tumor histology, as well as the disease stage according to permanent histopathology. Results: The mean age at diagnosis was 64.0 years. There were 17 (65.3%) women with pure ECCC and 8 (30.7%) women with a mixed histology. Stage III-IV disease was diagnosed in 12 (46.2%) women and occurred more frequently in pure ECCC (n = 11, 91.7%). CA-125 values were significantly higher in advanced stage disease. Cytological evaluation indicated the presence of 71.4% (10/14) cytological abnormalities in pure ECCC. The overall sensitivity of endometrial sampling for the detection of malignancy was 92.3% (24/26), whereas the accurate diagnosis of ECCC was only 34.7% (8/23) with the Pipelle sampler. Conclusion: Pap test abnormalities are frequent in ECCC. Although it is less accurate in the diagnosis of ECCC than in the detection of malignancy, endometrial sampling is still the main procedure for the diagnosis of ECCC. Higher preoperative CA-125 concentrations imply the presence of advanced stage ECCC.

Survival outcomes and the prognostic significance of clinicopathological features in patients with endometrial clear cell carcinoma: a 35-year single-center retrospective study

“…Chao et al found that elevated serum CA125 levels usually indicate deep MI, extrauterine spread, positive PWC, lymph node metastasis, advanced-stage disease, and recurrence [ 17 ]. In line with the literature [ 18 ], one-third of the patients (46/144, 31.9%) in our cohort had elevated serum CA125 levels and 30 of 46 (65.2%) patients were diagnosed with stage III–IV disease. Compared to patients with early-stage disease, those with advanced-stage disease had a higher prevalence of positive LVSI, mixed histology, deep MI, positive PWC, and elevated serum CA125 levels ( p < 0.05).…”

“…Compared to patients with early-stage disease, those with advanced-stage disease had a higher prevalence of positive LVSI, mixed histology, deep MI, positive PWC, and elevated serum CA125 levels ( p < 0.05). However, Cetinkaya et al found that the prevalence of advanced-stage disease was significantly higher in patients with pure ECCC than in those with mixed histological subtypes ( p = 0.04) [ 18 ]. These results contradict the findings of this study.…”

Sensitivity of cervico‐vaginal cytology in endometrial carcinoma: A systematic review and meta‐analysis

“…We identified 45 studies 19,20,23,25,29‐69 that were eligible for meta‐analysis and included a total of 6599 women who had been diagnosed with endometrial cancer. Most of the included studies were performed in North America (n = 21); the other studies were performed in Asia/Oceania (n = 13), Europe (n = 10), and Africa (n = 1).…”

Survival analyses of patients with non-endometrioid endometrial carcinoma

“…Coherent with the literature, the study demonstrated that elevated preoperative serum CA 125 level was an independent risk factor for survival. Also, high CA 125 is associated with extrauterine involvement and disseminated disease [27][28][29].…”