Association of Abnormal Pap Smear with Occult Cervical Stromal Invasion in Patients with Endometrial Cancer

Document Type: Research Articles

Authors

Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kean, Thailand.

Abstract

Objective: The purpose of this study was to determine the association between abnormal preoperative Pap smear
results and occult cervical stromal invasion in endometrial cancer patients. Methods: Medical records were reviewed of
patients with endometrial cancer who had undergone surgical staging at Srinagarind Hospital. Patients with gross cervical
involvement, with an unsatisfactory Pap smear, without available Pap smear results, with no cervical intraepithelial
lesion/invasive cervical cancer, or who had previously undergone pelvic radiation therapy were excluded. The patients
were assigned to one of two groups according their Pap smear results (negative and epithelial cell abnormalities).
Logistic regression was used to determine the independent association between an abnormal Pap smear and the risk
of cervical stromal invasion. Results: All cervical smears in this study were performed as conventional Pap smears.
Smears were abnormal in 50 (21.0%) of the 238 patients enrolled and normal in the remaining 188 (79.0%). The types
of Pap smear abnormalities included adenocarcinoma (n=22); atypical endometrial cells (n=2); atypical glandular cells
(n=17); high-grade squamous intraepithelial lesions (n=4); atypical squamous cells, cannot exclude high-grade squamous
intraepithelial lesions (n=2); and atypical squamous cells of undetermined significance (n=3). After controlling for type of
endometrial cancer, abnormal Pap smear results were found to be a significant independent factor that indicated cervical
stromal invasion (adjusted OR 2.65; 95% CI 1.35 to 5.21). Conclusion: Endometrial cancer patients with abnormal
Pap smears were strongly and independently associated with histopathologically diagnosed cervical stromal invasion.

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