# Vaginal Tumor Cell Exfoliation in Cervical and Endometrial Cancer: A Comparative Washing Cytology Study with Implications for Minimally Invasive Surgery

## TL;DR

This study found that tumor cells are more likely to be released into the vaginal cavity during cervical cancer than endometrial cancer, which may explain why minimally invasive surgery has worse outcomes for cervical cancer.

## Contribution

The study provides evidence that tumor cell exfoliation during surgery may be a key mechanism affecting outcomes in minimally invasive cervical cancer surgery.

## Key findings

- Positive cytology was detected in 33.3% of cervical cancer cases versus 6.5% in endometrial cancer.
- Cervical cancer was an independent predictor of positive cytology (OR 14.24).
- Advanced FIGO stage (III–IV) was also an independent predictor (OR 9.53).

## Abstract

Background/Objectives: Minimally invasive surgery (MIS) is widely used for gynecologic malignancies, but the LACC trial reported significantly worse survival in early-stage cervical cancer compared with open surgery, raising concerns about its oncologic safety. Tumor cell spillage during intracorporeal colpotomy in the Trendelenburg position has been proposed as a potential mechanism underlying these findings. This study aimed to assess the presence of tumor cells exfoliated into the vaginal cavity in cervical and endometrial cancers using vaginal washing cytology. Methods: We retrospectively analyzed patients newly diagnosed with cervical or endometrial cancer between June 2021 and February 2025. Vaginal washing cytology was performed before treatment and interpreted. Chi-square or Fisher’s exact tests and multivariate logistic regression were used to identify factors associated with positive cytology. Results: Positive cytology detected more often in cervical than in endometrial cancer (all stages: 33.3% [12/36] vs. 6.5% [3/46], p = 0.002; early stage: 24.0% [6/25] vs. 0% [0/38], p = 0.003). Multivariate analysis confirmed cervical cancer (OR 14.24, 95% CI 1.83–110.89, p = 0.011) and FIGO stage III–IV (OR 9.53, 95% CI 2.08–43.61, p = 0.004) as independent predictors. Conclusions: Tumor cells exfoliated into the vagina were significantly more frequent in cervical cancer, supporting a mechanism by which intracorporeal colpotomy may allow peritoneal entry. Further studies should reassess MIS for early-stage cervical cancer, considering transvaginal colpotomy in the horizontal position.