The usefulness of clinical measurements of cell proliferation in gynecological cancer.

This article critically reviews the available methods for the assessment of cell proliferation in clinical practice, and evaluates their applications as diagnostic and prognostic variables in gynecological cancer. The mitotic count is not a standardised method and should not be considered to have inherent value as a measurement of cell proliferation in the clinical situation. In distinguishing benign and malignant uterine smooth muscle tumors, the degree of mitotic activity can only be interpreted in the context of the other pathological and clinical findings. Cytological atypia and the absence of stromal differentiation appear to be more accurate than mitotic activity in delineating high-grade endometrial stromal sarcomas. The potential biological behavior of placental site trophoblastic tumor cannot be reliably predicted on the basis of mitotic counts, and hysterectomy remains the treatment of choice for this condition. Flow cytometry produces accurate cell kinetic data and provides useful prognostic information in ovarian and endometrial tumors. The value of flow cytometry in cervical cancer is questionable and needs clarification. Complete and partial hydatidiform moles are generally distinguishable on the basis of ploidy studies. However, in view of the existence of a diploid partial mole, serial human chorionic gonadotrophin measurement is the only reliable method of establishing or excluding a diagnosis of persistent trophoblastic disease. The other clinical markers of cell proliferation do not have an established role as diagnostic or prognostic parameters in gynecological cancer and merit further critical evaluation. Estimation of mitotic activity is a simple, readily accessible method of assessing cell proliferation in routine histopathological practice and the role of an accurate mitotic index in diagnosis and prognosis must be investigated to determine the true value of counting mitotic figures in histological sections.