[Value of gynecological cytology and CA 125 level for the prediction of extrauterine malignancy in endometrial cancer].

OBJECTIVE

To determine the value of gynaecological cytology and CA 125 level in preoperatively predicting extrauterine malignancy in endometrial cancer.

METHODOLOGY

This retrospective study evaluated 225 women with endometrial cancer that underwent surgery between January 1996 and January 2010 at the Centre hospitalier universitaire de Sherbrooke. CA 125 level, gynaecological cytology, and histopathological data were available for each patient. Statistical analyses relied on chi-square test and Fisher exact test, as well as on a multivariable logistical regression model.

RESULTS

At diagnosis, 163 patients (72.5%) presented with a stage 1 malignancy. A correlation between bad prognosis histopathological factors (grade 3, lymphovascular invasion and myometrial invasion ≥ 50%, lymph-node metastases at histology: clear cell, seropapillary and undifferentiated, P = 0.05) and the combination of an increased CA 125 level (≥ 35 U/mL) and an abnormal gynaecological cytology (glandular anomalies) was discovered. Moreover, an extrauterine malignancy is found in 69.4% of patients with an increased CA 125 level and an abnormal gynaecology cytology, compared to 19.6% of patients with normal results (P < 0.001). According to multivariate analyses of preoperative factors, the combination of these two tests is the most powerful predictor of extrauterine malignancy in endometrial cancer (OR 9.3; 95% CI 4.2 to 20.7). When both results are found to be preoperatively abnormal, final histopathology analysis will reveal the presence of an extrauterine malignancy in 49.1% to 83.2% of patients.

CONCLUSION

The preoperative evaluation of women with endometrial cancer should include routine evaluation of CA 125 level and routine gynaecological cytology, since the combination of these two tests offers crucial data on the probability of a stage FIGO ≥ 2 illness thus facilitating preoperative triage of high risk patients. A pelvic or para-aortic lymphadenectomy should be offered to patients with increased CA 125 level and abnormal gynaecological cytology by a competent professional.