Liquid‐based endometrial cytology: cyto‐histological correlation in a population of 917 women

Abstract

Liquid-based endometrial cytology: cyto-histological correlation in a population of 917 women Objective: Liquid-based cytology, because of its capacity to reduce the obscuring factors and to provide thin-layer specimens, represents an opportunity to reevaluate endometrial cytology. In order to assess the utility of the liquid-based method in endometrial diagnosis, we evaluated its accuracy in comparison with histology. Methods: Nine hundred and seventeen women scheduled for hysteroscopy were enrolled in the study. After providing informed consent, all the women proceeded sequentially to hysteroscopy, endometrial cytology and then biopsy endometrial sampling. Results: Cyto-histological correlations were possible in 519 cases (57%): in 361 (39%) cases the biopsy was inadequate, in 15 (2%) the cytology was inadequate, and in 22 (2%) both were inadequate. At biopsy 25 (3%) women had adenocarcinoma, 5 (1%) had adenomatous atypical hyperplasia and 21 (2%) had simple non atypical hyperplasia. At cytology two adenocarcinomas and one adenomatous atypical hyperplasia were underrated as atypical hyperplasias and as non-atypical hyperplasia; two simple non-atypical hyperplasias were reported as negative; and eight cases were false positive (non-atypical hyperplasia at cytology, negative at biopsy). In our population, the cytology provided sufficient material more often than biopsy (P < 0.04). Sensitivity was estimated at 96%, specificity at 98%, positive predictive value at 86% and negative predictive value at 99%. Conclusions: We concluded that endometrial cytology may be an efficient diagnostic method. It could be applied to selected patients solely or in association with ultrasonography. The combination of these two noninvasive procedures may improve their diagnostic accuracy and reduce unnecessary hysteroscopies, thereby producing benefits for women and society.Keywords: endometrial neoplasms, uterine neoplasms, cytodiagnosis, cytological techniques, ThinPrep, LBC, liquid-based cytology IntroductionEndometrial adenocarcinoma ranks fifth in incidence among malignancies in women, and it is the most frequent malignancy of the female genital tract in developed countries. The majority of the cases are sporadic whereas about 10% are hereditary. Most important among the latter, is the autosomal dominantly inherited non-polyposis colorectal cancer caused by mutation of a DNA mismatch repair gene that determines constitutive microsatellite instability and Cowden syndrome in patients with germ line PTEN inactivation. Two subtypes of endometrial carcinoma, named type I and type II, have been described on the basis of their different age of development, aetiopathogenesis, histopathological features and prognosis. Type I adenocarcinoma, which accounts for most cases (approximately 80%), occurs in peri-menopausal women, is oestrogen dependent, more often well differentiated and endometrioid, and has a favourable behaviour with appropriate therapy. Conversely, the rare type II endometrial adenocarcinoma affects older postmenopausal wo...

Evaluation of Endometrial Cytology: Cytohistological Correlations in 1,441 Cancer Patients

“…The authors concluded that the tumors localized to a polyp or small area of the endometrium may go undetected by the instrument. Buccoliero et al [13] found that cytology provided sufficient material more often than biopsy, and showed the benefit of endometrial liquid-based cytology. Furthermore, a low correlation rate between D&C and Pipelle biopsy of 79% for histological diagnosis was reported in 127 cancer and noncancer patients [14].…”

The Role of Liquid-Based Preparation in the Evaluation of Endometrial Cytology

“…The main advantages of this procedure are the reduction in confounding factors, the distribution of cells on a thin layer and the possibility to obtain more slides from the same sample. The two LBP technologies currently in use include ThinPrep (Hologic Inc., Bedford, Mass., USA) and SurePath (BD Diagnostics, Burlington, N.C., USA) and several groups have reported their experience either by using ThinPrep [10,11,14,15] or SurePath [8,9,12,13] methods. There are subtle differences between ThinPrep and SurePath preparations which reflect different sampling devices, collection media and processing techniques [20,21,22,23].…”

“…In fact, the LBP method enables storage of a variable amount of cells. Recently, several studies have described the cellular assessment of endometrial lesions by using cytoarchitectural criteria on LBPs [8,9,10,11,12,13,14,15]. The above described advantages of LBPs versus conventional slides suggest the replacement of conventional slides with LBPs in the routine cytologic evaluation of endometrial cell samples.…”

New Terminology for Intrauterine Endometrial Samples: A Group Study by the Japanese Society of Clinical Cytology

“…Because the sensitivity and specificity of TVS were 97.4 and 75.7%, respectively, they concluded that TVS was more useful in identifying patients who required further diagnostic investigation, including endometrial histology. Buccoliero et al [7] studied 917 patients who were scheduled for hysterectomy with the liquid-based cytology method. All the women proceeded sequentially through hysteroscopy, endometrial cytology and endometrial biopsy.…”

“…According to their study, cytology provided more sufficient information than biopsy; sensitivity and specificity were 96 and 98%, respectively, PPV was 86% and NPV was 99%. In addition, several studies have mentioned the sensitivity and specificity of endometrial cytology [7,8,9]. In these studies, cytologically ‘positive’ was also determined for the first time.…”