PROGNOSTIC-SIGNIFICANCE OF MALIGNANT CERVICAL CYTOLOGY IN PATIENTS WITH ENDOMETRIAL CANCER

Objective: To determine the prognostic importance of malignant cervica l cytology before surgical staging in patients with endometrial cancer . Methods: Between September 1987 and August 1993, 164 patients with e ndometrial cancer had preoperative cervical cytology examined before s urgical staging, which included pelvic and para-aortic lymphadenectomy . Results: Ninety-four patients (57.3%) had normal cervical cytology, 21 (12.8%) had atypical cytology suspicious for malignancy, and 49 (29 .9%) had malignant cytology on preoperative cervical cytology. Statist ically significant associations were found between cervical cytology a nd histopathology (P =.017), tumor grade (P =.001), cervical metastase s (P <.001), surgical stage (P =.035), pelvic lymph node metastases (P =.016), and para-aortic lymph node metastases (P =.006). Patients wit h malignant cytology were more likely to have non-endometrioid histolo gy, poorly differentiated malignancies, higher surgical stage, and cer vical, pelvic lymph node, and para-aortic lymph node metastases. Patie nts with malignant cervical cytology had a 3.5 times higher prevalence of pelvic lymph node metastases and a five times higher prevalence of para-aortic lymph node metastases than patients with normal cytology. No association was found between preoperative cervical cytology and t he depth of myometrial invasion, adnexal metastases, omental metastase s, or malignant pelvic peritoneal cytology. Conclusions: Patients with endometrial cancer and malignant preoperative cervical cytology are a t marked risk for extrauterine metastases, including pelvic and para-a ortic lymph node metastases. Such patients should be considered for pr imary surgical staging, including pelvic and paraaortic lymphadenectom y.