UTILITY OF THE CERVICAL CYTOLOGIC SMEAR IN ASSESSING ENDOCERVICAL INVOLVEMENT BY ENDOMETRIAL CARCINOMA

OBJECTIVE: To evaluate the possible contribution of cervical cytology in the identification of high-risk endometrial cancer patients. STUDY DESIGN: A retrospective study of 61 patients who had a preoperative ce rvical cytologic smear and hysterectomy at our institution for endomet rial carcinoma. The smear and endocervical curetting (ECC) results wer e compared with the status of the endocervix in the hysterectomy speci mens. RESULTS: Two patterns of malignant endometrial cells were identi fied in the 25 positive smears: (1) a sloughing pattern, which was the classic rounded cell pattern associated with the exfoliation of endom etrial cancer cells, and (2) an abraded pattern in which the cancer ce lls were present as loosely cohesive, sheetlike groups that retained t he original cell shape. This pattern was associated with the endocervi cal involvement by endometrial cancer and overlapped with the criteria for primary cervical adenocarcinoma. Using the histologic status of t he endocervix in the hysterectomy specimen as the standard, cervical c ytology compared favorably with ECC in predicting the status of the en docervix. Pitfalls included bulky or polypoid lesions that abutted the endocervical canal and smears taken when the endometrium were sloughi ng. Reactive endocervical cells presented diagnostic dilemmas in patie nts who had had endometrial sampling prior to the smear. When restrict ed to cases in which the smear preceded endometrial sampling, the smea r was superior to ECC in predicting endocervical involvement. CONCLUSI ON: These results suggest that preoperative smears may be valuable in assessing cervical involvement by endometrial carcinoma. It is recomme nded that a smear be performed as an initial procedure in any woman wi th complaints of abnormal uterine bleeding.