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

Abstract

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