• Vol. 40 No. 2, 80–83
  • 15 February 2011

The Contribution of Rapid Intraoperative Cytology in the Evaluation of Endometrial Cancer Spread



Introduction: Peritoneal washing cytology and imprint cytology of pelvic lymph nodes samples were used to evaluate the rapid cytologic detection of peritoneal and retroperitoneal spread of endometrial cancer.

Materials and Methods: We undertook a study on 194 endometrial cancer patients who underwent primary treatment in the Gynecologic Clinic, Democritus University of Thrace. All patients were subjected to peritoneal washing (PW) cytology and imprint cytology performed on lymph node sampling. The cytologic specimens were stained by May-Grünwald Giemsa (MGG) and Haematoxylin eosin (HE) techniques. Cell-blocks prepared from peritoneal washings (PWs) and the lymph node samples were sent for histologic examination. The cytologic findings were correlated to histologic results.

Results: Rapid intraoperative cytology provides a useful diagnostic technique for the assessment of endometrial cancer spread. HE and MGG stain presented different values of sensitivity and specificity in the detection of peritoneal and retroperitoneal spread of endometrial cancer.

Conclusion: Cytologic assessment of intraperitoneal and retroperitoneal spread of endometrial cancer is a rapid, intraoperative procedure, which provides the surgeon with useful information regarding the stage of the disease and the subsequent therapeutic approach.

Tumour staging is of great importance to the treatment of patients with oncological diseases. The therapeutic approach of the patient largely depends on the extension of the disease. Misclassification of stage may thus result in suboptimal treatment strategies. The International Federation of Gynecology and Obstetrics (FIGO) adopted its first staging system for endometrial cancer in 1971. This clinical staging system used information obtained from routine pretreatment laboratory and diagnostic studies, careful pelvic examination, uterine sounding and fractional histologic sampling from the endocervical canal and endometrial cavity. When a number of studies showed on the basis of surgical findings that clinical staging was subjected to a high rate of error, the Cancer Committee for FIGO established a surgical staging system in 1988. This system recognised a number of prognostic features that were shown to have significant impact on the risk of recurrence and survival. While histologic grade, depth of myometrial invasion and extension to the cervix are important prognostic features associated with the primary uterine tumour, endometrial cancers that have spread to retroperitoneal lymph nodes or to sites within the peritoneal cavity are at especially high-risk for recurrence. Survival rates for patients with extrauterine disease are less than 50%.

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