Preoperative Cervical Cytology Research Articles

Reason for improper simple hysterectomy in invasive cervical cancer in Northeast India.

The objective of the study was to determine the reasons for improper simple hysterectomy in the presence of invasive cervical cancer in Northeast India. The medical records of 52 patients who had undergone improper simple hysterectomy in the presence of invasive cervical cancer and were referred to a tertiary regional cancer Institute at Guwahati, Assam, between January 2015 and December 2019 were reviewed. Most of the patients presented with abnormal vaginal bleeding (40.4%). The failure to perform cervical cytology before the operation was quite high at 48.1% (25 patients). Interestingly, normal cytologic smear could still be found in 15.4% (8 patients) despite the presence of invasive cervical cancer. Failure to perform preoperative Papanicolaou smear, incomplete evaluation of cervical intraepithelial neoplasia (CIN) on cervical biopsy, and negative Papanicolaou smear accounted for 75% of the patients undergoing inappropriate simple hysterectomy. The most common indications for inappropriate operation were abnormal vaginal bleeding (40.4%) and CIN (19.2%). The reasons for inappropriate simple hysterectomy included lack of preoperative cervical cytology (48.1%), false-negative cervical cytology (15.4%), incomplete evaluation of cervical dysplasia or microinvasion on biopsy (11.5%). failure to perform indicated conization( 5.8%), emergency hysterectomy (3.8%), errors in colposcopic examination (3.8%), incomplete evaluation of an abnormal cervical cytology (3.8%), failure to review slide (3.8%) and failure to biopsy a gross cervica lesion (3.8%). Most improper simple hysterectomy resulted from deviation from guideline for cervical cancer detection protocols. Improper simple hysterectomy in the presence of invasive cervical cancer can be avoided if one sticks to the diagnostic guideline for patients with an abnormal cervical cytology.

Preoperative cervical cytology as a prognostic factor in endometrioid-type endometrial cancer: A single-center experience from Saudi Arabia.

ABSTRACTObjectives:The objectives of this study were (1) to estimate the frequency of preoperative abnormal cervical cytology (CC), (2) to explore correlations between preoperative CC and specific clinicopathological prognostic factors (tumor stage, endometrioid grade, myometrial invasion, lymphovascular space involvement, cervical involvement, and recurrence), and (3) to examine the impact of preoperative CC on disease-free survival (DFS) and overall survival (OS) in Saudi patients with endometrioid-type endometrial cancer (EC).Materials and Methods:A retrospective cross-sectional study was conducted at a tertiary hospital in Saudi Arabia. The study’s inclusion criteria included: (1) patients who underwent staging operation for EC from 2010–2014, (2) patients who had preoperative CC results within 3 months before staging operation, and (3) patients with final histopathological diagnosis of endometrioid-type EC.Results:Hundred and sixteen patients (n = 116) met the study’s inclusion criteria. CC results were abnormal in 46 patients (39.7%). Patients with abnormal CC had statistically significant higher rates of unfavorable Grades II–III tumor and cervical involvement than patients with normal CC (P = 0.004, chi-square test). There were no statistically significant differences (log-rank test) between patients with normal and abnormal CC with regard to DFS (P = 0.525) and OS (P = 0.166). Multivariate analyses of DFS and OS (Cox proportional hazards model) failed to show preoperative CC as a significant independent prognostic factor of DFS and OS (P > 0.05).Conclusion:The frequency of abnormal preoperative CC in patients with endometrioid-type EC is not uncommon. Abnormal CC correlates with poor prognostic factors, namely high tumor grade and cervical involvement. Preoperative CC is not a significant independent prognostic factor of survival.

Presence of Glandular Cells at the Preoperative Cervical Cytology and Local Recurrence in Endometrial Cancer.

We investigated the correlation between glandular cells (GC) detected at preoperative cervical-smear and the histologic findings and oncologic outcomes in patients undergoing surgery for endometrial cancer (EC). We retrospectively analyzed data of all consecutive EC patients who underwent surgery between January 1, 1990 and December 31, 2012 with preoperative cervical smear performed within 3 mo from the EC diagnosis. Basic descriptive, logistic regression and artificial neural network analyses were used. Five-year disease-free survival and overall survival were assessed using Kaplan-Meier and Cox hazard models. The study included 229 (89%) and 29 (11%) patients with normal cytology (control group) and GC (GC group), respectively. A higher proportion of elderly patients with nonendometrioid and FIGO grade 3 EC was observed in the GC group compared with the control group (P<0.05). No differences in 5-yr disease-free survival and overall survival were observed. However, patients in the GC group experienced a higher local recurrence rate (hazard ratio: 7.6; 95% confidence interval: 1.7-34.2; P=0.008). We observed that age, body mass index, cervical stromal invasion, vaginal brachytherapy, and GC influenced the risk for developing local recurrence. However, at the multivariable analysis, only cervical stromal invasion (odds ratio: 1.2; 95% confidence interval: 1.02-1.4; P=0.02) and GC (odds ratio: 1.07; 95% confidence interval: 1.01-1.14; P=0.03) correlated with the increased risk. In addition, the results of an artificial neural network analysis reported that the most critical predictor of local failure was cervical stromal invasion (importance: 0.352) followed by GC (importance: 0.194). These results suggest that cervical stromal invasion and presence of GC at the preoperative cervical smear might predict the occurrence of local recurrence in EC.

Contribution of cervical cytology in the diagnostic work-up of patients with endometrial cancer.

Abnormal cervical cytology in patients with endometrial cancer (EC) has been associated with poor outcome. The aim of this study was to evaluate whether cervical cytology could contribute to an improved preoperative identification of high-grade EC (serous, clear cell, carcinosarcoma, high-grade endometrioid EC) in final histology. A retrospective cohort study was performed in five hospitals in the Netherlands. A total of 554 patients with EC that underwent primary surgical treatment between 2002 and 2010 were included. Primary outcome was defined as the contribution of abnormal cervical cytology in the preoperative identification of high-grade EC. As secondary outcome, recurrence-free survival (RFS) and disease-specific survival were determined based on preoperative cervical cytology, and compared to the currently established risk factors: myometrial invasion, high-grade and lymph vascular space invasion. Abnormal cervical cytology was present in 45.1%. For patients with preoperative inconclusive and high-grade histology, the presence of abnormal cervical cytology contributed to an improved identification of high-grade EC in final histology (odds ratio [OR] 6.40 [95% confidence interval {CI}: 1.92-21.26]; OR 2.86 [95% CI: 1.14-7.14]), respectively. Patients with abnormal cervical cytology had a significant worse 5-year median RFS. Abnormal cervical cytology was independently related to RFS (hazard ratio 1.67 [95% CI: 1.04-2.68]) and disease-specific survival (hazard ratio 3.15 [95% CI: 1.74-5.71]). Abnormal cytology contributes to the preoperative identification of patients with high-grade EC, and is associated with compromised outcome. Future studies are warranted to determine whether cervical cytology could be incorporated into preoperative prediction models for lymph node metastasis.

To Assess the Safety of Morcellation for Removing Uterine Specimen During Laparoscopic and Vaginal Hysterectomies for Leiomyomas

The ability to offer less invasive surgery for leiomyomas to women often requires the removal of large tissue specimens through small incisions, which is facilitated by morcellation. Electromechanical morcellation may lead to dissemination of occult uterine malignancy throughout the intraperitoneal cavity and may worsen the prognosis. To assess the safety of morcellation for removing uterine specimen during laparoscopic and vaginal hysterectomies for leiomyoma and to find incidence of leiomyosarcoma (LMS) in morcellated specimens. This study was a retrospective case series done at Aarogya Hospital and Test Tube Baby Centre, Raipur, from January 1, 2011 to November 30, 2015. Total 232 cases were analyzed to assess the safety of vaginal and laparoscopic morcellation technique. All histopathological reports were analyzed to find incidence of LMS in morcellated specimen. In the study period 55.55% hysterectomies were performed for fibroid uterus. All patients were multiparous and 82.75% had not attained menopause. Preoperative cervical cytology and endometrial biopsy reports were not suggestive of malignancy in any case. Histopathology reports of all the morcellated specimens were consistent with leiomyoma. The risk of occult LMS is extremely low, especially in reproductive age group women. We believe that more studies and guidelines are required for Indian women.

Preoperative Cervical Cytology and E-Cadherin Expression in Endometrial Cancer

Objective: It is reported that cervical cytology is a significant factor related to stage, tumor grade, nodal metastasis, recurrence and survival rate in endometrial cancer. Moreover, reduced expression of the cell adhesion molecule E-cadherin is associated with higher tumor grade and metastasis in endometrial cancer. The objective of this study is to evaluate the relationship between the results of cytological assessment of glandular cells in cervical cytology before surgery, prognostic factors, and E-cadherin expression in endometrial cancer. Methods: Between 2004 and 2011, 263 patients with endometrial cancer at all stages were treated with hysterectomy. We reviewed preoperative cervical smears and assigned each to one of three categories: (1) Negative, (2) Atypical glandular cells (AGC), and (3) Adenocarcinoma (AC). The relationship of these cytology, prognostic factors, and E-cadherin expression was evaluated. Results: Statistical significance in overall survival was shown for preoperative cervical cytology, age, surgical stage, histological type, tumor grade, myometrial invasion, cervical involvement, lymph node metastasis except peritoneal cytology. Patients with AC cytology were more likely than those with normal cervical cytology to have a higher International Federation of Gynecology and Obstetrics (FIGO) stage, poorer histopathology, higher tumor grade, deeper myometrial invasion, higher incidence of cervical involvement, and higher prevalence of lymph node metastasis. In addition, AC and AGC cytology appeared to be associated with a poorer prognosis and to have lower E-cadherin expression than negative cytology. Conclusions: Cervical cytology may be a guide to prognosis in endometrial cancer, and E-cadherin expression may correlate with appearances of abnormal endometrial cells.

Outcomes of Women With Atypical Glandular Cells on Preoperative Cytology and Endometrial Cancer

This study aims to examine the prognostic importance of preoperative cervical cytologic diagnosis with atypical glandular cells (AGC) or malignant cells (MC) as a predictor of poor outcomes in endometrial cancer. A total of 563 patients were surgically staged for endometrial adenocarcinoma from 2002 to 2012 at our institution. Of these patients, 106 were included to perform a case-control study (39 patients with AGC or MC and 67 controls). Included patients were not significantly different from excluded patients and were matched for age, race, and body mass index. Outcome variables included presence of extrauterine disease (International Federation of Gynecology and Obstetrics stage ≥II) and high intermediate risk (HIR) disease. Further analysis sought to improve the prediction combining AGC or MC with other factors, such as grade and CA-125 levels. Standard statistical analyses were used. Among the patients with AGC or MC, 53.8% had HIR disease compared with 30.3% with normal cervical cytologic diagnosis (odds ratio [OR], 2.68; 95% confidence interval [CI], 1.18-6.09; P = 0.02). Extrauterine disease was found in 43.6% of patients with AGC or MC compared with that of 15.2% in patients with normal cervical cytologic diagnosis (OR, 4.33; 95% CI, 1.72-10.90; P < 0.01). Multivariate analysis confirmed that AGC or MC was an independent predictor of HIR disease (OR, 8.41; 95% CI, 1.34-52.78; P = 0.02) and extrauterine disease (OR, 4.78; 95% CI, 1.26-18.1; P = 0.02). The combination of elevated CA-125 levels with AGC or MC cervical cytologic diagnosis increased the statistical prediction of extrauterine disease (OR, 13.3; 95% CI, 3.1-56.8; P < 0.01) and HIR disease (OR, 5.83; 95% CI, 1.44-23.71; P = 0.02). Patients with AGC or MC on preoperative cervical cytology are at risk for extrauterine and HIR disease. These preoperative findings should warn surgeons of the potential of extrauterine or occult metastatic disease.

Cervical Cytology in Serous and Endometrioid Endometrial Cancer

The aim of this study was to determine the frequency of abnormal cervical cytology in preoperative cervical cytology of patients diagnosed with uterine papillary serous carcinoma (UPSC) and endometrioid endometrial carcinoma (EEC). In addition, associations between abnormal cervical cytology and clinicopathologic factors were evaluated. In this multicentre study, EEC patients diagnosed at two hospitals from 1999 to 2009 and UPSC patients diagnosed at five hospitals from 1992 to 2009, were included. Revision of the histologic slides was performed systematically and independently by 3 gynecopathologists. Cervical cytology within six months before histopathologic diagnosis of endometrial carcinoma was available for 267 EEC and 80 UPSC patients. Cervical cytology with atypical, malignant, or normal endometrial cells in postmenopausal women was considered as abnormal cytology, specific for endometrial pathology. Abnormal cervical cytology was found in 87.5% of UPSC patients, compared with 37.8% in EEC patients. In UPSC, abnormal cytology was associated with extrauterine spread of disease (P=0.043). In EEC, abnormal cytology was associated with cervical involvement (P=0.034). In both EEC and UPSC patients, abnormal cervical cytology was not associated with survival. In conclusion, abnormal cervical cytology was more frequently found in UPSC patients. It was associated with extrauterine disease in UPSC patients, and with cervical involvement in EEC patients. More prospective research should be performed to assess the true clinical value of preoperative cervical cytology in endometrial cancer patients.

Robotic-assisted laparoscopic trachelectomy: a case series and review of surgical technique.

We present a retrospective case series of patients who underwent robotic-assisted laparoscopic trachelectomies from August 1, 2011 to August 30, 2012, with a description of the surgical technique for successful cervical removal. The patients, at the Department of Obstetrics and Gynecology, Division of Urogynecology and Minimally Invasive Surgery at Penn State Milton S. Hershey Medical Center, were identified using ICD-9 coding for robotic-assisted trachelectomy. Of the 180 patients who had robotic-assisted gynecologic surgery during the study period, eight underwent robotic-assisted laparoscopic trachelectomy. The patients' average age was 40.4years, average parity was 1.5, and mean body mass index was 28. The time interval from initial surgery of supracervical hysterectomy to robotic-assisted trachelectomy was 4years. Pre-operative cervical cytology was negative in all patients. The average length of stay was one overnight admission. The primary indication for prior supracervical hysterectomy was dense pelvic adhesions, and the main indications for robotic-assisted trachelectomy were pelvic pain due to endometriosis and cyclic vaginal bleeding. Surgical outcomes included minimal blood loss (<50ml) and mean operative time of 1.15h (74.88min), without any immediate intra-operative or post-operative complications reported. Histopathology reports on all cervical specimens were normal. Adnexectomy is the most common concomitant procedure performed with trachelectomy. Robotic-assisted laparoscopic trachelectomy is a viable option for patients requesting a minimally invasive approach to cervical stump removal.

Implication of preoperative cervical cytology in endometrial carcinoma

ABSTRACT Background and aim: The objective of this study was to evaluate the relationship between preoperative cervical cytology and clinicopathologic factors associated with prognosis in endometrial carcinoma. Methods: We reviewed all Pap smears and histologic sections from 108 patients who underwent hysterectomy for endometrial carcinomas. Abnormal cervical cytology was defined as the presence of atypical cells and malignancy. Results: Forty‐one patients (38%) had abnormal cervical cytology on preoperative Pap smears, and 67 patients (62%) had normal cytology. Abnormal cervical cytology was statistically correlated with higher FIGO grade, advanced FIGO stage, myometrial invasion, lymphovascular invasion, cervical involvement, polypoid growth pattern, non‐endometrioid histology, and tumor size. Tumor grade, stage, histologic type, cervical involvement, lymph node metastasis, and serosal involvement were associated with survival. Multivariate analysis showed that lymph node metastasis was related to survival. However, abnormal cervical cytology was not an independent prognostic indicator for survival. Conclusion: Abnormal preoperative cervical cytology is associated with poor prognostic factors. However, cervical cytology itself neither influences treatment decision nor predicts poor prognosis in endometrial carcinoma.

Subtotal Vaginal Hysterectomy with Sacrospinous Ligament Fixation for Treatment of Uterine Prolapse

We report a case of severe uterine prolapse in a 43-year-old woman. She had presented with menorrhagia, dyspareunia, and backache for several years, which were treated (unsuccessfully) with medication. Preoperative cervical biopsy and cytology were benign. Vaginal subtotal hysterectomy and sacrospinous ligament fixation were performed, and the endocervix and exocervix were then ablated electrosurgically to minimize the potential of vaginal bleeding and neoplastic transformation. It allowed for a normal social and sexual life for this patient.

Preoperative Cervical Cytology in Endometrial Carcinoma and Its Clinicopathologic Relevance

Objective.The aim of this study was to assess the significance of malignant or suspicious cervical cytology in preoperative identification of poor prognostic factors in endometrial carcinoma and to determine whether preoperative abnormal cervical cytology is an independent prognostic factor for endometrial carcinoma.Methods.We evaluated the correlation between preoperative cervical cytology and postoperative clinicopathologic findings, sites of metastasis, and receptor status from 99 surgically staged patients with endometrial carcinoma.Results.Sixty-eight patients (68.7%) had normal cervical cytology, 1 (1.0%) had atypical cytology suspicious for malignancy, and 30 (30.3%) had malignant cytology on preoperative cervical cytology. Malignant and suspicious cervical smears were statistically correlated with surgical stage (P= 0.001), histopathology (P= 0.010), tumor grade (P= 0.012), depth of myometrial tumor invasion (P= 0.001), cervical involvement (P= 0.01), lymph node metastases (P= 0.002), adnexal metastases (P= 0.012), progesterone receptor (P= 0.007), and estrogen receptor (P= 0.031). No association was found between preoperative cervical cytology and patients' age or peritoneal cytology. Univariate analysis showed that cervical cytology was related to survival (P= 0.018). However, multivariate analysis of cervical cytology, stage, grade, and myometrial invasion showed that preoperative cervical cytology was not a significant prognosticator for survival.Conclusion.Patients with endometrial carcinoma who have malignant or suspicious cytology detected by preoperative cervical cytology are at increased risk of having known poor prognostic factors. However, positive preoperative cervical cytology itself does not appear to be an independent prognostic factor and probably should not influence treatment decisions in endometrial cancer.

Cytologic studies of highly malignant endometrial stromal sarcoma arising in the cervix uteri A case report.

An endometrial stromal sarcoma arising in the cervix uteri of a 29-year old female in which positive preoperative cervical cytology was obtained is described. Possible origin of the tumor in pre-existing endometriosis or in an ectopic stromal nest is hypothesized and the cytologic presentation in cervical smears is described.