Does cervicovaginal cytology have a role in the diagnosis and surveillance of endometrial adenocarcinoma?

Abstract

Objective To examine the role of cervicovaginal cytology in diagnoses and surveillance of the patients with endometrial carcinoma (EC). Methods Patients who underwent EC surgery that included a follow‐up were reviewed retrospectively. The cohort was limited to the patients who had an available cervical cytology result within 12 months before the primary surgery took place. The glandular abnormalities were classified in the following subclassifications: “atypical glandular cells” (AGC)‐not otherwise specified (NOS), AGC‐favor neoplasia, endocervical AIS, and adenocarcinoma. Results A total of 411 patients were eligible for the study. The cervical cytology was found to be normal and recorded as negative for intraepithelial lesion or malignancy in 368 (89.5%) patients. In 43 (10.5%) patients, cervical cytology was interpreted as: AGC‐NOS (n = 11), AGC‐FN (n = 7), adenocarcinoma (n = 20), malignant epithelial tumor (n = 3), and squamous carcinoma (n = 2). During the follow‐up, recurrence was observed in 53 (12.9%) patients. Among six isolated vaginal cuff recurrences, two of the cases presented with malignant cytology, and the additional four cases were suspected during clinical examination. Among women with recurrence (n = 53), there were malignant cytological findings in four of the patients. In the whole population (n = 411), there were four other abnormal cytological findings detected within the surveillance. These four cytology results were nonmalignant and no recurrence was identified. Conclusion There is no significant clinical advantage of cervicovaginal cytology testing before diagnosis or during the surveillance of EC.

Who needs an endometrial biopsy when cervical cytology finds endometrial cells?

“…In our study, the same conclusion was not reached, which may be because many factors, such as comorbidities, abnormal vaginal bleeding, and endometrial thickness, were included in our analysis. A review of cervical cytology in patients with endometrial cancer found that the detection rate of abnormal cervical cytology for endometrial cancer was 10.5%-31.7% [12][13][14] . In this study, there were 7 cases of endometrial atypical dysplasia/endometrial cancer, accounting for 4%, because our inclusion criteria were patients with endometrial cells found in cervical cytology rather than all patients with endometrial cancer.…”