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 cervical cytologic smear and hysterectomy at our institution for endometrial carcinoma. The smear and endocervical curetting (ECC) results were compared with the status of the endocervix in the hysterectomy specimens.
Results: Two patterns of malignant endometrial cells were identified in the 25 positive smears: (1) a sloughing pattern, which was the classic rounded cell pattern associated with the exfoliation of endometrial cancer cells, and (2) an abraded pattern in which the cancer cells were present as loosely cohesive, sheetlike groups that retained the original cell shape. This pattern was associated with endocervical involvement by endometrial cancer and overlapped with the criteria for primary cervical adenocarcinoma. Using the histologic status of the endocervix in the hysterectomy specimen as the standard, cervical cytology compared favorably with ECC in predicting the status of the endocervix. Pitfalls included bulky or polypoid lesions that abutted the endocervical canal and smears taken when the endometrium was sloughing. Reactive endocervical cells presented diagnostic dilemmas in patients who had had endometrial sampling prior to the smear. When restricted to cases in which the smear preceded endometrial sampling, the smear was superior to ECC in predicting endocervical involvement.
Conclusion: These results suggest that preoperative smears may be valuable in assessing cervical involvement by endometrial carcinoma. It is recommended that a smear be performed as an initial procedure in any woman with complaints of abnormal uterine bleeding.