{
  "abstract": "Background: The relationship between uterine manipulation during minimally invasive surgery for endometrial cancer and intraoperative peritoneal tumor-cell shedding remains uncertain. We described serial cytological patterns across predefined operative landmarks without estimating manipulator-specific or irrigation-specific effects.\n\nMethods: This single-center observational process-monitoring study included patients undergoing laparoscopically initiated surgery between June 2018 and August 2024. Eligibility for the cytology-evaluable cohort required a final diagnosis of primary endometrial cancer and at least one evaluable intraoperative cytology result. The primary analysis included cup-assisted cases; no comparable no-manipulator hysterectomy group was available. Cytology was obtained before cup placement (T0), after hysterectomy (T1), after 1,000 mL sterile-water irrigation and saline-based sampling (T2), and after cumulative 2,000 mL irrigation and repeat sampling (T3). Abnormal cytology comprised suspicious/atypical or positive/malignant findings. Adjacent transitions were assessed with exact McNemar tests; complete trajectories required evaluable T0–T3 data. No cytology values were imputed.\n\nResults: Of 163 screened patients, 119 were cytology-evaluable, 113 underwent cup-assisted surgery, and 96 had complete T0–T3 data. Abnormal cytology occurred in 4/96, 6/96, 1/96, and 1/96 patients at T0, T1, T2, and T3, respectively. A T0-negative to T1-abnormal transition occurred in 5/94 patients (5.3%; 95% confidence interval [CI], 1.7–12.0). Five of six T1-abnormal results were suspicious/atypical and one was positive/malignant; all six were negative at T2 (100.0%; 95% CI, 54.1–100.0). The T1-to-T2 comparison included seven discordant pairs (exact McNemar P = 0.125). At the administrative data cutoff of May 1, 2026, 94 of the 119 cytology-evaluable patients (79.0%) had a verifiable last follow-up date, whereas 25 (21.0%) were lost to follow-up; no recurrence was documented among the 94 patients with confirmed follow-up.\n\nConclusions: Serial cytological changes were uncommon, but sparse events, indeterminate findings, incomplete sampling, procedural heterogeneity, absence of appropriate surgical and irrigation controls, and lack of centralized rereview, biological validation, recovered-volume measurement, and irrigation-specific safety assessment limit interpretation. Negative T2 cytology indicates non-detection in one specimen, not biological elimination. These exploratory findings should not guide manipulator use, routine sterile-water irrigation, or operative practice and do not establish safety, cytotoxic efficacy, recurrence prevention, or oncological benefit.\n\nClinical trial number: Not applicable. This observational intraoperative cytology study did not allocate participants to therapeutic interventions.\n\nSupplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12905-026-04780-w.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350000 China"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Wei Chen"
    },
    {
      "affs": [
        0
      ],
      "name": "Ling Lin"
    },
    {
      "affs": [
        0
      ],
      "name": "Bin Liu"
    },
    {
      "affs": [
        0
      ],
      "name": "Huaijing Shi"
    },
    {
      "affs": [
        0
      ],
      "name": "Weiting Chen"
    },
    {
      "affs": [
        0
      ],
      "name": "Jianping Zou"
    },
    {
      "affs": [
        0
      ],
      "name": "Hongju Chen"
    },
    {
      "affs": [
        0
      ],
      "name": "Xiao Chen",
      "orcid": "0009-0000-5230-5103"
    },
    {
      "affs": [
        0
      ],
      "name": "Yang Sun",
      "orcid": "0000-0002-1587-9797"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ejdyvqsnzxcax.bib",
  "cited_by": 0,
  "doi": "10.1186/s12905-026-04780-w",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13729636/",
  "id": "ejdyvqsnzxcax",
  "issns": [
    "1472-6874"
  ],
  "landing_url": "https://doi.org/10.1186/s12905-026-04780-w",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Research"
    ],
    [
      "openalex",
      "2729|Endometrial and Cervical Cancer Treatments"
    ]
  ],
  "openalex": "W7196935961",
  "pdf_url": null,
  "pmcid": "PMC13729636",
  "pmid": "42977974",
  "published": "2026-08-07",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/ejdyvqsnzxcax.ris",
  "sources": [
    {
      "first_seen": "2026-11-07T12:22:21Z",
      "native_id": "PMC13729636",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s12905-026-04780-w"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2729|Endometrial and Cervical Cancer Treatments",
      "subfield": "reproductive-child"
    }
  ],
  "title": "Temporal patterns of serial intraoperative peritoneal cytology among patients undergoing cup-assisted surgery for endometrial cancer: a single-center observational process-monitoring study",
  "title_text": "Temporal patterns of serial intraoperative peritoneal cytology among patients undergoing cup-assisted surgery for endometrial cancer: a single-center observational process-monitoring study",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:22:21Z",
  "url": "https://research.draconitic.com/paper/ejdyvqsnzxcax",
  "venue": "BMC Women's Health",
  "versions": []
}