Delving into Depths of Peritoneal Wash Cytology positivity in Uterine Cancer

The impact of positive peritoneal cytology was initially recognized by International Federation of Gynecology and obstetrics [FIGO] in the year 1988, where it was classified as stage III.A. However, due to varying results from subsequent studies, the 2009 FIGO revision no longer considers positive peritoneal cytology as a criterion for upstaging or as an independent prognostic factor. The current article analyzes the literature on the significance of peritoneal cytology, particularly in the era of minimally invasive surgery and molecular classification.

We searched PubMed, Ovid, Science Direct, Scopus, EMBASE and Cochrane library and Google scholar and identified articles regarding peritoneal wash cytology in carcinoma endometrium. Out of around150 articles, only those pertaining to prognosis of peritoneal wash cytology were reviewed.

We got a total of 152 articles, and 46 relevant articles were reviewed. The occurrence of peritoneal wash cytology positivity is around 11% in uterine cancer. The considerable heterogeneity of the cohorts across various studies and wide time span of these studies make definitive conclusions difficult in early endometrial cancer. This leads to multiple treatment approaches like expectant management or adjuvant chemotherapy. Hormonal therapy is increasing favored as adjuvant therapy for low-grade early-stage carcinoma endometrium with positive peritoneal cytology. The options of whole abdominal radiation therapy with newer techniques, intra-operative radiotherapy and photodynamic therapy can be explored further.

The dilemma in adjuvant treatment is largely settled with newer molecular classification which got incorporated into FIGO staging, lately in 2023 update. The custom tailoring of adjuvant treatment depending on individual molecular characteristics of tumors is the road ahead.