Liquid‐based endometrial cytology in the management of sonographically thickened endometrium

Abstract

Liquid-based cytology represents an opportunity to re-evaluate endometrial cytology. We evaluated the accuracy of liquid-based endometrial cytology as compared to biopsy in 670 women scheduled for histeroscopy because of thickened endometrium (>4 mm), as evaluated by transvaginal sonography. Endometrial biopsy detected pathology in 41 (6%) of cases (21 of which were adenocarcinomas). Cytologic study found pathology in 62 (9%) cases (19 of which were adenocarcinomas). Two hundred ninety-one biopsies (43%) and 28 (4%) cytologies were inadequate. The sensitivity and the specificity were estimated, respectively, at 95% and 98%; the positive and negative predictive values were estimated, respectively, at 83% and 99%. Cytology provided sufficient material more often than biopsy (P < 0.01). We consider endometrial cytology an efficacious diagnostic opportunity. It could be usefully applied in association with transvaginal sonography. The combination of these procedures might reduce more invasive and expensive diagnostic procedures. Diagn. Cytopathol. 2007;35:398-402. ' 2007 Wiley-Liss, Inc.Key Words: thin-layer; liquid-based; endometrial cytology; endometrial adenocarcinoma; endometrial hyperplasia Endometrial adenocarcinoma is the most common malignancy of the female genital tract. A significant increase in its frequency, both absolute and relative, has been observed during the last decades. This increase is considered the consequence of the extended life expectancy of women, the increase in the incidence of risk factors, and of the reduction of invasive cervical carcinomas. Nowadays, more than 1 in 20 female cancers in Europe are of the endometrium. [1][2][3][4][5][6][7][8][9][10] Contrary to cervical carcinoma, no screening programs have been organized for the early detection of endometrial adenocarcinoma. The lack of screening programs may be related to the precocious presenting symptoms and to the relative good prognosis of the majority of endometrial adenocarcinomas. Early abnormal uterine bleeding, the commonest presenting symptom for the 95% of women, allows diagnosis at stage I in 73% of cases. 11 Moreover, there has not been an endometrial test comparable to cervicovaginal cytology for diagnostic reliability, tolerability, and low cost.Several diagnostic procedures are used for investigating the endometrium, but there is no common agreement for the optimum approach in each circumstance (i.e. symptomatic vs. asymptomatic; with risk factors vs. without risk factors).Endometrial cytology has been hampered in its dissemination by the difficulty in its interpretation due to the common presence of excess blood and overlapping cells. Liquid-based cytology represents an opportunity to reexamine endometrial cytology. We conducted the current study to correlate the results of liquid-based endometrial cytology with the results of endometrial biopsy in a group of 670 women scheduled for hysteroscopy because of thick endometrium (>4 mm), as evaluated by transvaginal sonography (TVS). Our purpose was preliminarily to asce...

A reporting system for endometrial cytology: Cytomorphologic criteria—Implied risk of malignancy

“…Different studies reported very good results when direct endometrial sampling was performed, especially when combined with liquid‐based cytology . Our experience in the application of the ThinPrep® methodology, since 2003, confirms the already known and established advantages of the technique . The application of this technique contributed to the standardization of the process steps involving material preservation, fixation and slide preparation.…”

“…The proposed classification scheme is intended for use in the everyday practice of medical consultation of clinicians. Critical is the provisioning of accurate and appropriate clinical data available in hand before sample examination, as well as endometrial thickness on ultrasound scan . Essential is the interaction between cytopathologists and gynecologists for two reasons: to obtain adequate sample, properly handled before arrival to the cytological laboratory and for clinicians to have the required comprehension for the utilization of the cytological report and subsequent handling of patients based on risk of malignancy.…”

“…The mean age of diagnosis for endometrial carcinoma in the USA is 60 years 6 whereas in the UK is 61 years 7 and in most European countries 63. 8 The probability of carcinoma occurrence according to age distribution is as follows: 0% for women younger than 20, 1.6% for women aged 20-34, 6.1% for women aged [35][36][37][38][39][40][41][42][43][44]19.2% for women aged 45-54, 31.8% for women aged 55-64, 22.1% for women aged 65-74, 14.2% for women aged 75-84 and 4.8% for women older than 84. 9 The most common symptom of endometrial carcinoma is postmenopausal bleeding 10 ; however, only 10% of cases of postmenopausal bleeding are due to endometrial carcinoma.…”

Endometrial carcinoma in high‐risk populations: is it time to consider a screening policy?

“…The overall sensitivity and specificity of cytology were 95% and 66% when EC and atypical cytology specimens were considered to be positive. Overall, cumulative data in the literature on nearly 4000 patients revealed a sensitivity ranging from 78% to 100% and specificity from 95% to 100%, with a PPV of 78–100% and NPV of 96–100% …”

“…Overall, cumulative data in the literature on nearly 4000 patients revealed a sensitivity ranging from 78% to 100% and specificity from 95% to 100%, with a PPV of 78-100% and NPV of 96-100%. [24][25][26][27][28][29][30][31][32][33][34][35][36] In some studies, endometrial LBC revealed a very high diagnostic accuracy in the early detection of EC, even in troublesome subgroups of women, such as tamoxifen users, postmenopausal women or patients with low-risk endometrial polyps. Tamoxifen has represented the standard adjuvant therapy in the management of women with endocrine-responsive breast cancer, but its oestrogenic activity can promote endometrial pathologies such as polyps, hyperplasias and cancers.…”