Temporal patterns of serial intraoperative peritoneal cytology among patients undergoing cup-assisted surgery for endometrial cancer: a single-center observational process-monitoring study
- 1Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350000 China
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.
Methods: 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.
Results: 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.
Conclusions: 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.
Clinical trial number: Not applicable. This observational intraoperative cytology study did not allocate participants to therapeutic interventions.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12905-026-04780-w.
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BibTeX
@article{chen2026temporal,
title = {{Temporal patterns of serial intraoperative peritoneal cytology among patients undergoing cup-assisted surgery for endometrial cancer: a single-center observational process-monitoring study}},
author = {Wei Chen and Ling Lin and Bin Liu and Huaijing Shi and Weiting Chen and Jianping Zou and Hongju Chen and Xiao Chen and Yang Sun},
journal = {BMC Women's Health},
year = {2026},
month = aug,
doi = {10.1186/s12905-026-04780-w},
url = {https://doi.org/10.1186/s12905-026-04780-w},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Temporal patterns of serial intraoperative peritoneal cytology among patients undergoing cup-assisted surgery for endometrial cancer: a single-center observational process-monitoring study
AU - Wei Chen
AU - Ling Lin
AU - Bin Liu
AU - Huaijing Shi
AU - Weiting Chen
AU - Jianping Zou
AU - Hongju Chen
AU - Xiao Chen
AU - Yang Sun
PY - 2026
DA - 2026/08/07
JO - BMC Women's Health
DO - 10.1186/s12905-026-04780-w
UR - https://doi.org/10.1186/s12905-026-04780-w
AB - 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. Methods: 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. Results: 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. Conclusions: 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. Clinical trial number: Not applicable. This observational intraoperative cytology study did not allocate participants to therapeutic interventions. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12905-026-04780-w.
SN - 1472-6874
ER -