TITLE:
Back to Beginning: Peritoneal Wash Cytology in Endometrial Cancer—A Review of the Literature
AUTHORS:
Suvidya Singh, William Manning, Seema Singhal, Annekathryn Goodman
KEYWORDS:
Endometrial Cancer, Cytology, Peritoneal Wash
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.16 No.11,
November
19,
2025
ABSTRACT: Background: The role of peritoneal wash cytology (PWC) in endometrial cancer has fluctuated over five decades. It was introduced into FIGO endometrial cancer staging in 1988 as Stage IIIA but was removed in 2009 when evidence showed that cytology alone lacked independent prognostic value. In the molecular era, its relevance is being reconsidered. Methods: A systematic search of PubMed/MEDLINE, Embase, Web of Science, and Cochrane Library (inception—30 August 2025) identified studies assessing PWC in endometrial cancer. Eligible designs included cohort, case-control, randomized trials, meta-analyses, guidelines reporting recurrence and survival outcomes, and treatment recommendations. Results: Eighteen studies were included. Classic cohorts demonstrated no survival disadvantage with cytology-only positivity, supporting its removal from FIGO staging. However, national databases and meta-analyses suggested adverse prognostic associations, particularly in high-risk disease. Recent molecular-era studies highlight that PWC’s prognostic impact is subtype-specific: adverse in p53-abnormal and No Specific Molecular Profile (NSMP) tumors, but not in POLE-mutated or Mismatch Repair deficient (MMRd) cancers. Current National Comprehensive Cancer Network (NCCN) guidelines still incorporate PWC in treatment decisions for high-risk histology such as serous and clear cell carcinoma. Concerns remain regarding the iatrogenic consequences of surgical factors (e.g., hysteroscopy, distension media) influencing cytology results. Conclusion: PWC no longer defines stage but retains prognostic and therapeutic relevance in high-risk early-stage uterine cancers. Its value may be best realized when integrated with molecular classification. Future prospective, molecular-stratified studies are essential to determine its role in precision oncology.