Significance of Positive Pelvic Washing Cytology in Patients with Endometrial Cancer.
Beatrice B Lee, Michael H Roh, Carolyn M Johnston, Stewart M Knoepp. University of Michigan, Ann Arbor
Background: The 2010 American Joint Committee on Cancer (AJCC) guidelines no longer utilize peritoneal washings for staging determination of endometrial neoplasia. This position, which is based on data developed by the International Federation of Gynecology and Obstetrics (FIGO) in 2008, represents a departure from previous guidelines that incorporated pelvic washing cytology into staging schema. The AJCC maintains that the prognostic significance of peritoneal washings in this setting is “controversial” and that additional studies are needed. We sought to ascertain whether a positive pelvic washing cytology obtained at the time of tumor staging is of prognostic significance in patients with endometrial cancer.
Design: Patients diagnosed with endometrial cancer in the period from 1995 to 2009 at the study institution were identified utilizing available cancer center and pathology databases. The electronic medical record, pathology database, Cancer Center Tumor Registry, and State Registrar records were reviewed for tumor grade and stage at the time of surgery and clinical followup data with regards to recurrence. Two patient cohorts, based on staging designation according to the 1989 FIGO staging system, were selected and compared. Cohort 1 consisted of endometrial cancer patients with positive pelvic washings but, otherwise, with tumor confined to the uterine corpus (stage IIIA; T3a). Cohort 2 consisted of patients with stage I endometrial cancer (IA, IB and IC) with negative washings. The measured outcome was the presence or absence of recurrence. A minimum of one year follow-up was obtained for all patients.
Results: There were 30 and 72 patients within Cohorts 1 and 2, respectively. The latter cohort consisted of 24 stage IA patients, 36 stage IB patients, and 12 stage IC patients. Of the 30 patients within Cohort 1 (Stage IIIA), 3 patients had cancer recurrence. Of the 72 patients within Cohort 2, only 1 patient had cancer recurrence. The odds of disease recurrence for Cohort 1 was 7.88-fold higher than that for Cohort 2. The prognostic difference between cohorts was statistically significant (p = 0.0412).
Conclusions: Overall, irrespective of the findings on pelvic washing cytology, patients with endometrial cancer primarily involving the uterine corpus (Stage I disease; AJCC 7th ed) have a low likelihood of cancer recurrence. Nonetheless, patients with positive pelvic washings exhibit a significantly higher propensity for recurrence; hence, pelvic washing cytology is a relevant and important prognostic indicator.
Tuesday, March 1, 2011 8:30 AM
Platform Session: Section F, Tuesday Morning