Liquid-based endometrial cytology: its possible value in postmenopausal asymptomatic women

Abstract

The incidence of endometrial adenocarcinoma in asymptomatic women is low. Nevertheless, some of these women might require endometrial surveillance. In this study, we evaluated the accuracy of liquid-based endometrial cytology compared to biopsy in asymptomatic postmenopausal women. Three hundred twenty women scheduled for hysteroscopy were enrolled for this study. After hysteroscopy, patients were submitted to endometrial cytology and to biopsy. Two hundred ninety-three (92%) women had sonographically thickened endometrium (>5 mm), 53 (17%) were on tamoxifen, and 16 (5%) were on hormonal substitutive treatment. The evaluation of the biopsies determined that six (2%) women had adenocarcinoma, one (<1%) had adenomatous atypical hyperplasia, and eight (3%) had simple nonatypical hyperplasia. Endometrial cytology evidenced 5 (2%) neoplastic cases, 2 (<1%) hyperplastic with atypia cases, and 25 (8%) hyperplastic without atypia cases. Two hundred twenty-two biopsies (69%) and 17 (5%) cytologies were inadequate. One adenocarcinoma and one simple nonatypical hyperplasia were underrated by cytology resulting, respectively, as atypical hyperplasia and as negative. Four cases were false positive (simple nonatypical hyperplasias on cytology, negative on biopsy). The sensitivity and specificity were estimated, respectively, at 94% and 95%; the positive and negative predictive value were estimated, respectively, at 80% and 99%. Endometrial cytology provided sufficient material more often than biopsy (P < 0.01). We suggest to introduce liquid-based endometrial cytology in the management of some subpopulations of asymptomatic postmenopausal women. Particularly, the combination of liquid-based endometrial cytology and transvaginal sonography may improve their diagnostic accuracy and reduce unnecessary more invasive and expensive procedures.

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.…”

Cytological Scoring and Prognosis of Poorly Differentiated Endometrioid Adenocarcinoma

“…Many reports have described the usefulness of endometrial cytology for detecting endometrial carcinomas [9,10,11,12]. Moreover, screening tests using endometrial cytology for endometrial carcinomas may permit early detection and improve survival among patients with endometrial carcinomas [21].…”

“…Its diagnostic accuracy for endometrial carcinoma has been reported to be more than 90% [9,10,11,12]. Several criteria or reporting systems have been developed to evaluate endometrial cytological features in conventional and liquid-based preparations [13,14,15] based on cellular atypia and morphological features.…”

What is the best method of detecting endometrial cancer in outpatients?‐endometrial sampling, suction curettage, endometrial cytology

“…1 It was recently reported that office endometrial sampling using suction endometrial curettage is effective for diagnosis, while being simple to perform and generally well tolerated by patients without requiring anaesthesia. [5][6][7][8][9][10][11][12][13][14] The purpose of the present study was to determine the best method for detecting endometrial cancer in outpatients with abnormal uterine bleeding. [2][3][4] In addition, endometrial cytology is reported to be less painful than suction curettage, but its diagnostic accuracy for endometrial carcinoma ranges quite widely from 70% to 98%.…”