Feasibility of endometrial sampling by vaginal tampons in women with Lynch syndrome

Abstract

Background: Endometrial sampling for the surveillance of women with Lynch syndrome is an invasive and painful procedure. The aim of this study was to evaluate the feasibility of a less invasive procedure of collecting vital cells by vaginal tampons. Methods: This was a prospective feasibility study of women scheduled to undergo annual gynecological surveillance, including endometrial sampling. We included consecutive asymptomatic women with Lynch syndrome or first-degree relatives and asked them to insert a vaginal tampon 2-4 h before attending their outpatient appointment. Feasibility was evaluated by the following metrics: patient acceptance, pain intensity of each procedure (assessed by visual analog scale; range 0-10), and the presence of vital cells obtained by tampon-based or endometrial sampling methods. Two pathologists independently evaluated all samples. Results: In total, 25 of 32 approached women completed the tampon-based procedure, with 23 of these subsequently undergoing invasive endometrial sampling. The median visual analog scale scores for tampon use and invasive endometrial sampling were 0 (range, 0-10) and 5.5 (range, 1-10) (p < 0.001). None of the tampon samples analyzed by cytology showed endometrial cells, but they did contain vital squamous cells and granulocytes. By contrast, 18 (78%) of the invasive endometrial samples contained enough endometrial tissue for analysis. No endometrial abnormalities were found by endometrial sampling. Conclusions: Tampon-based endometrial surveillance was a well-accepted and non-painful procedure, and although tampons contained vital cells, they did not provide endometrial cells. However, this study was limited to asymptomatic women with Lynch syndrome (no endometrial pathology), indicating that research is needed to evaluate whether the tampon method has any utility for endometrial surveillance in women with Lynch syndrome.

Endometrial cancer in Lynch syndrome

“…Other alternative surveillance tools are also under investigation, including vaginal tampon‐based endometrial sampling, Pap test and urinary biomarkers for the detection of EC. Vaginal tampon‐based endometrial sampling is a noninvasive method that encourages patients to conduct home‐based self‐sampling, but its applicability and effectiveness need to be explored further 99 . A systematic review reported that the sensitivity of the Pap test was too low as a diagnosis method; however, advanced genetic and epigenetic technologies have provided a promising perspective 100 .…”

“…Vaginal tampon-based endometrial sampling is a noninvasive method that encourages patients to conduct home-based self-sampling, but its applicability and effectiveness need to be explored further. 99 A systematic review reported that the sensitivity of the Pap test was too low as a diagnosis method; however, advanced genetic and epigenetic technologies have provided a promising perspective. 100 In addition, urinary biomarkers for EC detection based on cytology, metabolomics, spectroscopy, transcriptomics and proteomics have also shown potential clinical benefits.…”

Detecting endometrial cancer

“…While tampons can be left in the vagina for several hours to collect a representative sample, they are uncomfortable for postmenopausal women to use. 68 Urine is the perfect biofluid for non-invasive sampling because it is easy to collect, with the potential for large volumes, repeat samples or collection at pre-specified times of the day. It depends on urinary excretion of systemic cancer biomarkers, or the reliable contamination of urinary flow with uterine-shed tumour debris.…”

“…These collection tools lend themselves to self‐sampling, enabling women to collect their own biofluids at home for postal return to the laboratory. While tampons can be left in the vagina for several hours to collect a representative sample, they are uncomfortable for postmenopausal women to use 68 …”