BACKGROUND The objective of the current study was to determine the diagnostic cytomorphologic criteria for liquid‐based cytology and to evaluate the reproducibility and usefulness of the cytologic diagnosis in endometrial lesions. METHODS A total of 162 direct endometrial samplings taken from postmenopausal women were evaluated by 2 skilled cytopathologists in endometrial cytology. The cytologic diagnosis was made according to the 1994 classification scheme of the World Health Organization. After establishment of the criteria, three additional cytopathologists without any experience in liquid‐based endometrial cytology examined the same cases to determine interobserver variability. The intraobserver variability also was evaluated by all the observers. RESULTS The cytomorphologic criteria were established in the following four diagnostic categories: atrophic endometrium, hyperplasia without atypia, hyperplasia with atypia, and adenocarcinoma. The overall interobserver agreement was nearly perfect with a κ value of 0.89 during the checking round and ranged from moderate to substantial with κ values of 0.48–0.80, respectively, in the other diagnostic rounds (P < 0.0001); hyperplasia with atypia was found to be the most difficult category to identify correctly. Furthermore, the intraobserver agreement ranged from substantial to perfect with κ values of 0.61–1.00 in all diagnostic rounds (P < 0.0001). CONCLUSIONS Liquid‐based cytology allows for standardized and reproducible endometrial preparations, which in turn allows the application of common diagnostic criteria among cytopathologists. Furthermore, liquid‐based cytology in combination with endometrial sampling could be a useful tool for the outpatient diagnosis of endometrial lesions, which could reduce unnecessary curettage. Cancer (Cancer Cytopathol) 2005. © 2005 American Cancer Society.

Endometrial sampling is complementary to D&C for the diagnosis of endometrial lesions and it is necessary for it to be performed before D&C and/or hysterectomy.

No abstract

Objective The aim of this study was to evaluate the diagnostic accuracy and efficiency of p16/ki-67 dual stain in the identification of CIN2+ lesions, in Greek women with ASCUS or LSIL cytology. Methods A total of 200 women, 20 to 60 years old, were enrolled in the study. All samples were cytologically evaluated and performed for p16/ki-67 and high-risk HPV (HR-HPV) test. All patients were referred to colposcopy for biopsy and histological evaluation. Three cervical cancer (CC) screening strategies were designed and the total direct medical costs of the procedures during our clinical trial were evaluated, from a healthcare perspective. Results HPV 16 as expected was the most common HR-HPV type followed by HPV 31 and HPV 51. The risk for CIN2+ was significantly higher in HPV 16/18 positive cases. p16/ki-67 demonstrated a high sensitivity for CIN2+ identification in both ASCUS and LSIL groups (90.4% and 95%, respectively). HR-HPV test with sensitivity 52.3% and 65.5%, as well as colposcopy with sensitivity 14.3% and 36% respectively in ASCUS and LSIL group, showed inferior results compared to p16/ki-67. The specificity of p16/ki-67 for ASCUS and LSIL was 97.2% and 95.2% respectively, inferior only to colposcopy: 100% and 100%, lacking however statistical significance. HR-HPV test instead, presented the lowest specificity: 76.4% and 71.4% respectively in comparison to the other two methods. From a healthcare perspective, the costs and benefits of the tests implementation for the annual screening and triaging, in three CC screening strategies, were also calculated and discussed. Conclusions The results of the study indicate that p16/ki-67 is a safe and rapid assay that could be used to detect CIN2+ among women with mild cervical lesions, presenting both high sensitivity and specificity and could minimize the psychological and economic burden of HPV screening.

No abstract