Pelvic washings for cytologic analysis in endometrial adenocarcinoma

The adoption of surgical staging into the management of endometrial adenocarcinoma has permitted improved accuracy in the study of prognostic variables in patients with limited disease. In an effort to resolve the current controversy about the importance of pelvic washings for cytologic analysis in endometrial cancer, 270 consecutive patients with neoplasms histologically limited to the uterus were studied. Fourteen patients (5.2%) were found to have positive results. Cytologic results correlated with tumor grade (P < .02) and depth of myometrial penetration (P < .02). Multivariate analysis indicated age 70 years or greater (P < .002), outer-third myometrial invasion (P < .004) and positive washings (P < .02) to predict survival. The probability of five-year survival in the total group was 0.85, which decreased to 0.67 in patients with positive washings. Despite statistical significance as a prognostic variable, the overall clinical utility of peritoneal cytology in planning postoperative adjuvant therapy in this series was limited by its correlation with other prognostic factors and overall low rate of positivity. Conclusions regarding effective adjuvant therapy for positive washings could not be drawn due to the smaller number of patients with abnormal results and the variety of treatments employed.