{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T13:41:30Z","timestamp":1760967690414,"version":"build-2065373602"},"reference-count":34,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T00:00:00Z","timestamp":1760832000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002447","name":"Daegu Catholic University","doi-asserted-by":"publisher","award":["20233006"],"award-info":[{"award-number":["20233006"]}],"id":[{"id":"10.13039\/501100002447","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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\u2019s 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\u2013110.89, p = 0.011) and FIGO stage III\u2013IV (OR 9.53, 95% CI 2.08\u201343.61, 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.<\/jats:p>","DOI":"10.3390\/jcm14207383","type":"journal-article","created":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T12:27:29Z","timestamp":1760963249000},"page":"7383","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Vaginal Tumor Cell Exfoliation in Cervical and Endometrial Cancer: A Comparative Washing Cytology Study with Implications for Minimally Invasive Surgery"],"prefix":"10.3390","volume":"14","author":[{"given":"Jung Min","family":"Ryu","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, School of Medicine, Daegu Catholic University, Daegu 42472, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8901-9434","authenticated-orcid":false,"given":"Youn Seok","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, School of Medicine, Daegu Catholic University, Daegu 42472, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8552-6049","authenticated-orcid":false,"given":"Sun-Jae","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pathology, School of Medicine, Daegu Catholic University, Daegu 42472, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoon Young","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, School of Medicine, Daegu Catholic University, Daegu 42472, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1093\/jnci\/87.11.796","article-title":"Prevalence of human papillomavirus in cervical cancer: A worldwide perspective. International biological study on cervical cancer (IBSCC) Study Group","volume":"87","author":"Bosch","year":"1995","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1136\/ijgc-2022-003703","article-title":"Updates on cervical cancer prevention","volume":"33","author":"Fernandes","year":"2023","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_3","first-page":"1531","article-title":"Obesity, endogenous hormones, and endometrial cancer risk: A synthetic review","volume":"11","author":"Kaaks","year":"2002","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1719","DOI":"10.1002\/ijc.31961","article-title":"Risk factors for endometrial cancer: An umbrella review of the literature","volume":"145","author":"Raglan","year":"2019","journal-title":"Int. J. Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.cct.2006.03.004","article-title":"Total laparoscopic versus open surgery for stage 1 endometrial cancer: The LACE randomized controlled trial","volume":"27","author":"Janda","year":"2006","journal-title":"Contemp. Clin. Trials"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1001\/jama.2017.2068","article-title":"Effect of Total Laparoscopic Hysterectomy vs. Total Abdominal Hysterectomy on Disease-Free Survival Among Women With Stage I Endometrial Cancer: A Randomized Clinical Trial","volume":"317","author":"Janda","year":"2017","journal-title":"JAMA"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"165.e1","DOI":"10.1016\/j.ajog.2010.02.027","article-title":"Long-term survival outcomes of laparoscopically assisted radical hysterectomy in treating early-stage cervical cancer","volume":"203","author":"Lee","year":"2010","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1093\/annonc\/mdr360","article-title":"Laparoscopic versus open radical hysterectomy in early-stage cervical cancer: Long-term survival outcomes in a matched cohort study","volume":"23","author":"Nam","year":"2012","journal-title":"Ann. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1895","DOI":"10.1056\/NEJMoa1806395","article-title":"Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer","volume":"379","author":"Ramirez","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1016\/S0002-9378(99)70372-8","article-title":"The effects of carbon dioxide pneumoperitoneum on seeding of tumor in port sites in a rat model","volume":"181","author":"Hopkins","year":"1999","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.tjog.2022.08.016","article-title":"Spillage and displacement of indocyanine green-stained tissues from uterine cervix to pelvic peritoneum: A proof of concept study for colpotomy approach in minimally invasive surgery","volume":"62","author":"Kong","year":"2023","journal-title":"Taiwan J. Obstet. Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1007\/978-1-4939-8935-5_22","article-title":"Making Formalin-Fixed, Paraffin Embedded Blocks","volume":"1897","author":"Sadeghipour","year":"2019","journal-title":"Methods Mol. Biol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1186\/s13000-022-01241-4","article-title":"A retrospective analysis of serous effusions based on the newly proposed international system for reporting serous fluid cytopathology: A report of 3633 cases in an oncological center","volume":"17","author":"Zhu","year":"2022","journal-title":"Diagn. Pathol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"160","DOI":"10.14218\/JCTP.2023.00025","article-title":"The International System for Reporting Serous Fluid Cytopathology-An Updated Review","volume":"3","author":"Wang","year":"2023","journal-title":"J. Clin. Transl. Pathol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1159\/000540414","article-title":"Risk of Malignancy in Effusions according to the International System for Serous Fluid Cytopathology: A Review","volume":"68","year":"2024","journal-title":"Acta Cytol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2741","DOI":"10.1200\/JCO.23.02335","article-title":"LACC Trial: Final Analysis on Overall Survival Comparing Open Versus Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer","volume":"42","author":"Ramirez","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1200\/JCO.2011.38.8645","article-title":"Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group LAP2 Study","volume":"30","author":"Walker","year":"2012","journal-title":"J. Clin. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.3802\/jgo.2023.34.e5","article-title":"Minimally invasive radical hysterectomy and the importance of avoiding cancer cell spillage for early-stage cervical cancer: A narrative review","volume":"34","author":"Fusegi","year":"2023","journal-title":"J. Gynecol. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.3390\/curroncol29020093","article-title":"Minimally Invasive Surgery for Cervical Cancer in Light of the LACC Trial: What Have We Learned?","volume":"29","author":"Touhami","year":"2022","journal-title":"Curr. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.1136\/ijgc-2020-001816","article-title":"Survival after minimally invasive surgery in early cervical cancer: Is the intra-uterine manipulator to blame?","volume":"30","author":"Nica","year":"2020","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"65.e1","DOI":"10.1016\/j.ajog.2020.07.025","article-title":"Impact of uterine manipulator on oncological outcome in endometrial cancer surgery","volume":"224","author":"Lago","year":"2021","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.ajog.2023.09.004","article-title":"Intrauterine manipulator during hysterectomy for endometrial cancer: A systematic review and meta-analysis of oncologic outcomes","volume":"230","author":"Zorzato","year":"2024","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1002\/(SICI)1097-0142(19990901)86:5<770::AID-CNCR11>3.0.CO;2-3","article-title":"The influence of pneumoperitoneum used in laparoscopic surgery on an intraabdominal tumor growth","volume":"86","author":"Volz","year":"1999","journal-title":"Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e73","DOI":"10.3802\/jgo.2018.29.e73","article-title":"Unexpected result of minimally invasive surgery for cervical cancer","volume":"29","author":"Kanao","year":"2018","journal-title":"J. Gynecol. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1111\/jog.12840","article-title":"Patterns of recurrence and survival after abdominal versus laparoscopic\/robotic radical hysterectomy in patients with early cervical cancer","volume":"42","author":"Kong","year":"2016","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Kim, J.M., Chong, G.O., Park, N.J., Choi, Y.E., Lee, J., Lee, Y.H., Hong, D.G., and Park, J.Y. (2022). Survival Impact of Residual Cancer Cells in Intraoperative Peritoneal Washes following Radical Hysterectomy for Cervical Cancer. J. Clin. Med., 11.","DOI":"10.3390\/jcm11092659"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1111\/aogs.13681","article-title":"Peritoneal contamination with ICG-stained cervical secretion as surrogate for potential cervical cancer tumor cell dissemination: A proof-of-principle study for laparoscopic hysterectomy","volume":"98","author":"Klapdor","year":"2019","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.3802\/jgo.2020.31.e7","article-title":"Selection criteria and colpotomic approach for safe minimally invasive radical hysterectomy in early-stage cervical cancer","volume":"31","author":"Kong","year":"2020","journal-title":"J. Gynecol. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1111\/ases.12915","article-title":"A simple technique of vaginal cuff closure to prevent tumor cell spillage in laparoscopic radical hysterectomy for uterine cervical cancer","volume":"14","author":"Deura","year":"2021","journal-title":"Asian J. Endosc. Surg."},{"key":"ref_30","first-page":"1332","article-title":"Vaginal Stump Ligation for Cervical Cancer","volume":"46","author":"Yang","year":"2017","journal-title":"Iran. J. Public. Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1016\/j.jmig.2019.01.016","article-title":"Laparoscopic Radical Hysterectomy with Enclosed Colpotomy and without the Use of Uterine Manipulator for Early-Stage Cervical Cancer","volume":"26","author":"Yuan","year":"2019","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Fusegi, A., Kanao, H., Ishizuka, N., Nomura, H., Tanaka, Y., Omi, M., Aoki, Y., Kurita, T., Yunokawa, M., and Omatsu, K. (2021). Oncologic Outcomes of Laparoscopic Radical Hysterectomy Using the No-Look No-Touch Technique for Early Stage Cervical Cancer: A Propensity Score-Adjusted Analysis. Cancers, 13.","DOI":"10.3390\/cancers13236097"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1136\/ijgc-2019-000388","article-title":"Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff\u2014A multicenter analysis","volume":"29","author":"Kohler","year":"2019","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1080\/13645706.2021.1982727","article-title":"Endobag use in laparoscopic gynecological surgeries: A systematic review","volume":"31","author":"Feghali","year":"2022","journal-title":"Minim. Invasive Ther. Allied Technol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/20\/7383\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T13:08:00Z","timestamp":1760965680000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/20\/7383"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,19]]},"references-count":34,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["jcm14207383"],"URL":"https:\/\/doi.org\/10.3390\/jcm14207383","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,19]]}}}