High Incidence of Positive Peritoneal Cytology in Low-Risk Endometrial Cancer Treated by Laparoscopically Assisted Vaginal Hysterectomy

Sonoda, Yukio; Zerbe, Marc J.; Smith, Alex; Lin, Oscar; Barakat, Richard R.; Hoskins, William J.

doi:10.1006/gyno.2000.6079

Cited by 132 publications

(39 citation statements)

References 17 publications

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“…Studies that support this view propose that endometrial carcinoma cells gain access to the peritoneal cavity via the fallopian tubes as a result of positive intrauterine pressure associated with minimally invasive surgical procedures. 87,[90][91][92] Peritoneal washings from minimally invasive hysterectomies were more likely to have malignant cells, as compared to those performed without the uterine manipulator. A study by Hu and Brown 90 showed that 7 of 37 peritoneal washings (20.6%) had malignant cells associated with minimally invasive hysterectomies as compared to 0 of 26 hysterectomies (0%) performed without a uterine manipulator in low-grade and low-stage endometrial carcinomas.…”

Section: Positive Peritoneal Washingmentioning

confidence: 99%

Recent Developments in Surgical Pathology of the Uterine Corpus

Hanley

Birdsong

Mošunjac

2017

Archives of Pathology &Amp; Laboratory Medicine

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There have been several updates recently on the classification of uterine tumors. Endometrial carcinomas have traditionally been divided into 2 types, but some are difficult to classify and do not fit readily into either of the currently recognized categories. The Cancer Genome Atlas Research Network has recently defined 4 new categories of endometrial cancer on the basis of mutational spectra, copy number alteration, and microsatellite instability, which might provide independent prognostic information beyond established risk factors. The Society of Gynecologic Oncology, moreover, now recommends systematic screening of every patient with endometrial cancer for Lynch syndrome. The new definition of high-grade endometrial stromal sarcoma disregards the number of mitotic figures as a primary diagnostic criterion and instead specifies moderate atypia still resembling stromal origin but lacking the pleomorphism of undifferentiated uterine sarcoma; these tumors also harbor a JAZF1-SUZ12 gene rearrangement. Mitotic count, atypia, and coagulative necrosis are the main histologic criteria that define leiomyosarcoma. Determining the type of necrosis can be very challenging in patients receiving various treatment modalities for symptomatic fibroids before myomectomy, since key histologic features of ischemic-type necrosis are often absent. Ancillary stains including p16, p53, MIB-1, trichrome, and reticulin may be helpful in tumors harboring necrosis that is difficult to classify. Minimally invasive gynecologic surgeries have introduced histologic artifacts that complicate the diagnosis. It is essential to recognize these as procedure-related artifacts to avoid upstaging tumors and triggering unnecessary adjuvant treatment.

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Section: Positive Peritoneal Washingmentioning

confidence: 99%

Recent Developments in Surgical Pathology of the Uterine Corpus

Hanley

Birdsong

Mošunjac

2017

Archives of Pathology &Amp; Laboratory Medicine

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“…There has been controversy in the past years as to whether laparoscopic hysterectomies are associated with higher rates of positive peritoneal washings, presumably related to the increased intrauterine pressure from the manipulator causing tumor cells to be propelled through the fallopian tubes into the peritoneal cavity. [4][5][6] As a result, many surgeons now ligate or clamp the tubes and/or obtain peritoneal washings before inserting the manipulator.…”

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confidence: 99%

Evaluation of vascular space involvement in endometrial adenocarcinomas: laparoscopic vs abdominal hysterectomies

et al. 2010

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Recent reports have described 'vascular pseudoinvasion' in total laparoscopic hysterectomies with endometrial carcinoma. To better understand this phenomenon, we compared pathologic findings in these laparoscopic and total abdominal hysterectomies performed for uterine endometrioid adenocarcinoma. Reports from 58 robotically assisted laparoscopic and 39 abdominal hysterectomies with grade 1 or 2 endometrioid endometrial adenocarcinomas were reviewed for stage, depth of invasion, vascular space involvement, uterine weight, and lymph node metastases. In addition, attention was given to possible procedural artifacts, including vertical endomyometrial clefts, and inflammatory debris, benign endometrial glands, and disaggregated tumor cells in vascular spaces. All foci with vascular involvement were reviewed by three gynecologic pathologists. Nine of the 58 (16%) laparoscopic and 3 of the 39 (7%) abdominal hysterectomies contained vascular space involvement based on the original pathology reports (P-value ¼ 0.0833). No one histologic feature consistently distinguished laparoscopic from abdominal cases on blind review of the available cases. Disaggregated intravascular tumor cells were significantly associated with reported vascular involvement in both procedures (P-valueso0.001 and 0.016), most of which were corroborated on review. Laparoscopic procedures tend to have a higher index of vascular involvement, which is associated with lower stage, fewer lymph node metastases, and less myometrial invasion; however, pathologists cannot consistently determine the procedure on histologic findings alone. Moreover, there is significant inter-observer variability in distinguishing true from artifactual vascular space involvement, even among pathologists at the same institution. The clinical significance of apparent true vascular space involvement seen adjacent to artifacts is unclear, as is the impact of laparoscopic hysterectomy on recurrence risk.

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“…The use of an intrauterine manipulator is not necessarily required to perform an adequate laparoscopic-assisted procedure and could prevent the retrograde dissemination of cancer cells into the peritoneal cavity during uterine manipulation. 40 Gamal H Eltabakh et al in a prospective study of laparoscopic surgical staging of clinical stage 1 endometroid endometrial carcinoma using Pelosi uterine manipulator have reported that it does not increase the incidence of positive peritoneal cytology. 41…”

Section: Uterine Manipulationmentioning

confidence: 97%

Advances in Minimal Access Surgery in the Surgical Staging of Carcinoma Endometrium

J¹

2011

WJOLS

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The concept of minimal access surgery for gynecologic malignancies has gone from a perceived near impossibility to a fully recognized option for many patients over the past 10 years. This article reviews the different minimal access techniques used for surgical staging of carcinoma endometrium, their outcome, feasibility and safety in comparison to conventional staging laparotomy. After review of literature, it is concluded that laparoscopic and robotic-assisted procedures are acceptable and safer alternatives to traditional laparotomy in the staging of carcinoma endometrium, especially in obese women. Long-term outcome reports for robotic surgery is awaited.ABSTRACT copyright holder's express written permission. However, users may print, download, or email articles for individual use.

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High Incidence of Positive Peritoneal Cytology in Low-Risk Endometrial Cancer Treated by Laparoscopically Assisted Vaginal Hysterectomy

Cited by 132 publications

References 17 publications

Recent Developments in Surgical Pathology of the Uterine Corpus

Recent Developments in Surgical Pathology of the Uterine Corpus

Evaluation of vascular space involvement in endometrial adenocarcinomas: laparoscopic vs abdominal hysterectomies

Advances in Minimal Access Surgery in the Surgical Staging of Carcinoma Endometrium

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