[1104] Incidence of Positive Pelvic Washings Obtained during Hysterectomy for Endometrial Adenocarcinoma: A Comparison of Robotic-Assisted Hysterectomy Versus Total Abdominal Hysterectomy

S Hu, Y Sun, A Brown, S Mandavilli. Hartford Hospital, Hartford

Background: Robotic-assisted hysterectomy (RH) is being increasingly used in patients undergoing treatment for endometrial adenocarcinomas (EACs). Pelvic washing specimens obtained during such procedures are evaluated for tumor cells and the presence of positive pelvic washings upstages the patients and may alter post-operative treatment. Having observed a case of grade 1 endometrial adenocarcinoma with no myometrial invasion that had positive washings, we wanted to examine the incidence of positive pelvic washings in RH when compared to total abdominal hysterectomy (TAH).
Design: 143 hysterectomy specimens with diagnosis of EAC were retrieved from the pathology files at a tertiary hospital for the period 2004 to the present time. This included 74 RH and 69 TAH specimens in which pelvic washing specimens were obtained. For purposes of analysis, all EACs were divided into low grade (LG) and high grade (HG) tumors. LG criteria included: EACs endometrioid type FIGO grade 1, nuclear grade 1-2, and < 50% myometrial invasion. HG criteria included: EACs endometrioid type FIGO grades 2-3, nuclear grade 3, serous & clear cell carcinomas and endometrioid carcinomas with > 50% myometrial invasion. All pelvic washing specimens with atypical cells were reviewed and compared with the primary EACs.
Results: 7 of 37 LG RH specimens and 0/26 LG TAH had positive pelvic washings. Of the 7 cases that were positive in the LG group undergoing RH, 5 cases had no myometrial invasion. The other two had <5% and 7% myometrial invasion respectively.

Positive Pelvic Washings in RH vs TAH
RHTAH
LG7/37 (20.6%)0/26 (0%)
HG11/37 (29.7%)8/43 (18.6%)



Conclusions: The incidence of positive pelvic washings in patients undergoing RH is higher compared to TAH. This was specially the case in LG EACs. This included cases in which there was no myometrial invasion and this raises the possibility that the positive pelvic washings are an artifact. Whether this represents a pre-operative spillage associated with hysterography, or direct seeding via the fallopian tube during hysterectomy warrants further investigation. The clinical significance of such “positive” pelvic washings is unclear but brings a possible procedural artifact to the attention of both surgeons and pathologists.
Category: Gynecologic & Obstetrics

Wednesday, March 24, 2010 9:30 AM

Poster Session V # 141, Wednesday Morning

 

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