CC BY-NC-ND 4.0 · Avicenna J Med 2020; 10(03): 111-117
DOI: 10.4103/ajm.ajm_147_19
Original Article

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

Ahmed Abu-Zaid
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, United States
Mohannad Alsabban
Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre
Osama Alomar
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre
Mohammed Abuzaid
Department of Obstetrics and Gynecology, King Fahad Medical City, Riyadh, Saudi Arabia
Mohammed Z Jamjoom
Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre
Hany Salem
Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre
Ismail A Al-Badawi
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre
› Author Affiliations

Subject Editor: Financial support and sponsorship Nil.


Objectives: 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.

Publication History

Article published online:
04 August 2021

© 2020. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

  • References

  • 1 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019; 69: 7-34
  • 2 Althubiti MA, Nour Eldein MM. Trends in the incidence and mortality of cancer in Saudi Arabia. Saudi Med J 2018; 39: 1259-62
  • 3 Costas L, Frias-Gomez J, Guardiola M, Benavente Y, Pineda M, Pavón MÁ. et al Screenwide Team. New perspectives on screening and early detection of endometrial cancer. Int J Cancer 2019; 145: 3194-206
  • 4 Nanda K, McCrory DC, Myers ER, Bastian LA, Hasselblad V, Hickey JD. et al. Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: A systematic review. Ann Intern Med 2000; 132: 810-9
  • 5 Nadaf A, Rani HSSP, Rao R, Shastri D. Pap smears in endometrial adenocarcinoma: Does it have a role?. Asian Pac J Cancer Prev 2017; 18: 1145-50
  • 6 DuBeshter B, Warshal DP, Angel C, Dvoretsky PM, Lin JY, Raubertas RF. Endometrial carcinoma: The relevance of cervical cytology. Obstet Gynecol 1991; 77: 458-62
  • 7 Larson DM, Johnson KK, Reyes Jr CN, Broste SK. Prognostic significance of malignant cervical cytology in patients with endometrial cancer. Obstet Gynecol 1994; 84: 399-403
  • 8 Fukuda K, Mori M, Uchiyama M, Iwai K, Iwasaka T, Sugimori H. et al. Preoperative cervical cytology in endometrial carcinoma and its clinicopathologic relevance. Gynecol Oncol 1999; 72: 273-7
  • 9 Gu M, Shi W, Barakat RR, Thaler HT, Saigo PE. Pap smears in women with endometrial carcinoma. Acta Cytol 2001; 45: 555-60
  • 10 Lai CR, Hsu CY, Hang JF, Li AF. The diagnostic value of routine Papanicolaou smears for detecting endometrial cancers: An update. Acta Cytol 2015; 59: 315-8
  • 11 Serdy K, Yildiz-Aktas I, Li Z, Zhao C. The value of Papanicolaou tests in the diagnosis of endometrial carcinoma: A large study cohort from an academic medical center. Am J Clin Pathol 2016; 145: 350-4
  • 12 Amkreutz LCM, Pijnenborg JMA, Joosten DWL, Mertens HJMM, Van Kuijk SMJ, Engelen MJA. et al. Contribution of cervical cytology in the diagnostic work-up of patients with endometrial cancer. Cytopathology 2018; 29: 63-70
  • 13 Brown AK, Gillis S, Deuel C, Angel C, Glantz C, Dubeshter B. Abnormal cervical cytology: A risk factor for endometrial cancer recurrence. Int J Gynecol Cancer 2005; 15: 517-22
  • 14 Shin DH, Choi KU, Suh DS, Yoon MS, Kim JY. Implications of preoperative cervical cytology in endometrial carcinoma. Basic Applied Path 2009; 2: 30-4
  • 15 Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 2009; 105: 103-4
  • 16 Nieminen P, Kallio M, Hakama M. The effect of mass screening on incidence and mortality of squamous and adenocarcinoma of cervix uteri. Obstet Gynecol 1995; 85: 1017-21
  • 17 Kitchener HC, Symonds P. Detection of cervical intraepithelial neoplasia in developing countries. Lancet 1999; 353: 856-7
  • 18 Frias-Gomez J, Benavente Y, Ponce J, Brunet J, Ibanez R, Peremiquel-Trillas P. et al. Sensitivity of cervico-vaginal cytology in endometrial carcinoma: A systematic review and meta-analysis. Cancer Cytopathol 2020. doi: 10.1002/cncy.22266. [Epub ahead of print]
  • 19 Koonings PP, Dickinson K, d’Ablaing 3rd G, Schlaerth JB. A randomized clinical trial comparing the cytobrush and cotton swab for Papanicolaou smears. Obstet Gynecol 1992; 80: 241-5
  • 20 Pretorius RG, Sadeghi M, Fotheringham N, Semrad N, Watring WG. A randomized trial of three methods of obtaining Papanicolaou smears. Obstet Gynecol 1991; 78: 831-6
  • 21 Chalvardjian A, De Marchi WG, Bell V, Nishikawa R. Improved endocervical sampling with the cytobrush. CMAJ 1991; 144: 313-7
  • 22 Kavak ZN, Eren F, Pekin S, Küllü S. A randomized comparison of the 3 Papanicolaou smear collection methods. Aust N Z J Obstet Gynaecol 1995; 35: 446-9
  • 23 Martin-Hirsch P, Jarvis G, Kitchener H, Lilford R. Collection devices for obtaining cervical cytology samples. Cochrane Database Syst Rev 2000; Cd001036
  • 24 Harrison DD, Hernandez E, Dunton CJ. Endocervical brush versus cotton swab for obtaining cervical smears at a clinic. A cost comparison. J Reprod Med 1993; 38: 285-8
  • 25 Nassar A, Fleisher SR, Nasuti JF. Value of histiocyte detection in pap smears for predicting endometrial pathology. An institutional experience. Acta Cytol 2003; 47: 762-7
  • 26 Zhou J, Tomashefski Jr JF, Khiyami A. Thinprep pap tests in patients with endometrial cancer: A histo-cytological correlation. Diagn Cytopathol 2007; 35: 448-53