Clinical management of the status of atypical endometrial cells using the descriptive reporting format for endometrial cytology

Abstract

ObjectiveWe aimed to develop and reinforce a clinical management regimen for atypical endometrial cell (ATEC) categories within the descriptive reporting format for endometrial cytology.MethodsBetween January 2013 and December 2014, 215 samples, for which histological examination was performed immediately or within 3 months after cytology, were cytologically diagnosed as ATEC. For these samples, the medical records were retrospectively reviewed to identify risk factors for malignancy.ResultsAmong 152 samples diagnosed as ATEC, of undetermined significance, 19 (12.5%) were malignant. In the younger group (age <55 years), the χ2 values of body mass index (BMI) ≥25 kg/m2 (5.85), gravidity (5.64) and parity (5.15) were relatively high, suggesting that these were risk factors for malignancy. Of the nulligravida patients, those with BMI ≥25 kg/m2, 28% were diagnosed with malignant disease. In the older group (≥55 years), endometrial thickening (6.84), atypical genital bleeding (6.43) and BMI ≥25 kg/m2 (3.79) were found to be risk factors for malignancy. Of the patients with endometrial thickening and atypical genital bleeding, 67% were diagnosed with malignant disease. Among 63 samples diagnosed as ATEC, cannot exclude atypical endometrial hyperplasia or more, 35 (55.6%) samples were positive for malignancy.ConclusionsHigh‐risk patients diagnosed with ATEC, of undetermined significance were identified. Endometrial biopsy should be considered for nulligravida patients aged <55 years with a BMI ≥25 kg/m2.

Application of immunocytochemical and molecular analysis of six genes in liquid‐based endometrial cytology

“…The new terminology for endometrial cytology has been introduced and now TYSEC system is usefully utilized. [1][2][3][4][5] However, diagnosis of gray zone category, ATEC, especially ATEC-US implies that clinicians would perform unnecessary biopsies. Accurate cytological diagnosis is required to maximize the merit of cytology, which seems less harmful than biopsy.…”

“…Recent studies have shown that nearly 10% of the cases assigned to cytological ATEC-US category had corresponding malignant histology. [3][4][5] Although cytological gray zone category intrinsically has some amount of corresponding malignant histology, if it is large, it could cause a problem for managing patients with a cytological diagnosis of ATEC-US. Therefore, it would be ideal to minimize the number of cytological diagnosis of ATEC.…”

Diagnostic value of endometrial cytology and related technology

“…21 However, several studies showed that increasing number of cases in gray zone category, especially ATEC-US in TYSEC, could cause problem in managing patients. [22][23][24] To solve the problem, a new approach to improve diagnostic accuracy have been expected. accuracy of endometrial carcinoma using thin-layer samples.…”

“…In order to improve diagnostic accuracy by standardization, sophisticated diagnostic algorithm by using LBC, the Osaki Study Group (OSG) method, was introduced as a reliable and reproducible method by a Japanese group 21 . However, several studies showed that increasing number of cases in gray zone category, especially ATEC‐US in TYSEC, could cause problem in managing patients 22–24 . To solve the problem, a new approach to improve diagnostic accuracy have been expected.…”

The Value of Shear Wave Elastography in Predicting the Risk of Endometrial Cancer and Atypical Endometrial Hyperplasia

“…Endometrial cancer is one of the common gynecological malignancies that threaten women's health, 1,2 especially for women in the perimenopausal and postmenopausal period, 3 and the incidence rate has been on the rise in recent years. Atypical endometrial hyperplasia (AEH) is the precancerous lesion for EC, and its pathological morphological manifestation is similar to that of highly differentiated EC 4,5 . The co‐incidence rate for AEH and EC were 15–55%, 6 and they are similar in clinical treatments and surgical methods.…”