PAPANICOLAOU SMEARS BY THE BETHESDA SYSTEM IN ENDOMETRIAL MALIGNANCY - UTILITY AND PROGNOSTIC IMPORTANCE

Objective: To evaluate the prognostic significance of the Bethesda sys tem's cytologic categories in patients with endometrial malignancy. Me thods: Patients with biopsy or hysterectomy-proven endometrial maligna ncy and a Papanicolaou smear result reported using the Bethesda system within 1 year of diagnosis were identified through retrospective revi ew of our computerized database. Results: After introduction of the Be thesda system in our laboratory on November 1, 1992, until January 1, 1997, 112 eligible patients were identified (108 with carcinomas and f our with carcinosarcomas). Patients with cytologic diagnoses of malign ancy (n = 17) were significantly more likely to have International Fed eration of Gynecology and Obstetrics (FIGO) grade 3 tumors and high-ri sk histology (serous, clear cell, and adenosquamous carcinoma and carc inosarcoma) than those with atypical glandular cells of uncertain sign ificance (n = 33) or those with cytology not suspicious for malignancy (n = 63). Patients with malignant smears were also significantly more likely to have cervical extension, malignant peritoneal cytology, and FIGO stage II, III, or IV than those with atypical glandular cells of uncertain significance or those with cytology not suspicious for mali gnancy. Conclusion: Papanicolaou smears obtained within 1 year of hist ologic diagnosis of endometrial malignancy and interpreted using the B ethesda system were suspicious for (atypical glandular cells of uncert ain significance) or diagnostic of malignancy in nearly half of all ca ses (29 and 15%, respectively). Patients having malignant glandular ce lls were more likely to have poor prognostic pathologic findings. (C) 1997 by The American College of Obstetricians and Gynecologists.