Is Peritoneal Cytology a Prognostic Factor in

The International Federation of Gynecology and Obstetrics (FIGO) changed the surgical staging criteria for endometrial cancer in 2009, namely combining FIGO 1988 Stage IA and IB in FIGO 2009 Stage IA, eliminating cervical glandular involvement from Stage II, and removing peritoneal cytology as criteria from Stage IIIA (3). This review of the literature sheds light on the continued debate among authorities on the utility of peritoneal cytology in surgical staging of endometrial cancer. At the time FIGO removed peritoneal cytology from the staging criteria in 2009, there was little to no evidence to support its removal. In fact, FIGO continues to recommend obtaining peri-toneal cytology, which is in contradiction to their staging criteria. While a few small studies sup-port the idea that peritoneal cytology does not preclude a worse prognosis, a number of large scale studies with at least 300 patients demonstrate a clear association between survival and the presence of malignant peritoneal cytology (11- 12, 15- 19). In one of the largest studies, investi-gators reviewed 14,704 from the SEER’s database, demonstrating that malignant peritoneal cytol-ogy is associated with decreased survival across Stage I/II disease even when controlled for his-tology, grade, and other risk factors. Malignant peritoneal cytology should be considered whe