Assessment of reliability endometrial brush cytology in detection etiology of late postmenopausal bleedings

We evaluated the possibility of discovering bleeding causes in late postmenopausal period with cytological examination of material received by endometrial brush in comparison with Pap test and fractionated curettage. Sixty-two women in late postmenopausal period with cervical canal bleeding, treated in gynecological department of clinical hospital in Osijek, were cytological and histological processed. Final diagnosis in 29 from 62 (46.8%) women with late postmenopausal bleeding was cancer. 25 (40.3%) women had endometrial adenocarcinoma and 4 (6.5%) of them had squamous endocervical carcinoma. Two women had endometrial precancerous (3.2%). With Pap test accurate diagnosis was set up in 13 from 25 (52.0%) women with endometrial adenocarcinoma and in all of them with squamous endocervical carcinoma. With endometrial brush accurate diagnosis was set up in 14 from 25 (56.0%) women with endometrial adenocarcinoma and in 3 from 4 (75.0%) women with squamous endocervical carcinoma. With fractional curettage the diagnosis of endometrial adenocarcinoma was accurately correct in 21 from 25 (84.0%) women and in all of them with squamous endocervical carcinoma. Cytological examination of material derived with endometrial brush, alike vaginal cytology, is not enough reliable method in our conditions for discovering bleeding causes in late postmenopausal period. Diagnostic exactness of procedure could be increased by histopathological examination of material from endometrial brush procedure and with ultrasound evaluation of endometrium thickness.An erratum to this article can be found at     

Endometrial brush biopsy in monitoring endometrial cytology during hormone replacement therapy

During the past few decades, a variety of diagnostic methods for endometrium direct sampling have been developed. One of these new techniques is endometrial brush biopsy (uterobrush). The principal aim of uterobrush is early detection of endometrial carcinomas and their precursors, but it may be also used to follow up the patients undergoing hormone replacement therapy (HRT). So far, there are only few clinical reports evaluating uterobrush as a technique useful in monitoring endometrial cytology during HRT. In this study the world literature on using brush biopsy to monitor endometrial condition of women receiving HRT has been reviewed.     

阴道超声及子宫腔细胞学联合检查绝经后妇女子宫内膜病变

目的 评估阴道超声及宫腔细胞学联合检查绝经后妇女子宫内膜病变的价值。方法 应用阴道超声测量143例绝经后子宫出血患者的子宫内膜厚度,并于当日或次日行宫腔细胞学检查及分段诊断性刮宫（诊刮）术,将内膜测量及宫腔细胞学检查结果与诊刮组织病理结果进行比较。结果 阴道超声检查施行率为100．0％,以5mm为临界值诊断绝经后内膜癌及癌前病变的敏感性为100．0％,假阳性率为56．9％;宫腔细胞学检查的施行率为97．9％,取材满意率为73．6％,特异性为96．3％,假阴性率为2．5％。两者联合应用后的假阳性率为43．2％（P＜0．01）,无一例内膜部中前病变漏诊。结论 阴道超声及宫腔细胞学联合检查,是一种较好的筛查内膜癌及癌前病变的方法,可减少诊刮。     

Vaginosonographic detection of endometrial cancer in postmenopausal women

In a prospective study 155 postmenopausal women not on hormone treatment underwent a vaginal ultrasound investigation. All women were routine patients of the regular ambulance. In addition to uterus biometry, the endometrial thickness was also measured. An endometrium of greater than or equal to 4 mm thickness was clarified histologically by means of a curettage. In total we found 7 endometrial cancers and 1 cervical cancer. Vaginal sonography proved to be a very sensitive (81%) and specific (89%) method for the detection of endometrial neoplasia.     

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

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.     

Assessment of the reliability of different methods in diagnosing endometrial cancer

OBJECTIVES: Endometrial cancer is the most common gynecologic malignancy. The purpose of the study was to compare the reliability of different methods for diagnosing endometrial cancer. DESIGN: A prospective study from January 1996 to September 1998. MATERIALS AND METHODS: 264 women at risk of endometrial cancer with clinical indications for hysteroscopy with curettage participated in the study. They underwent different diagnostic methods: endometrial cytology (121 cases), endometrial biopsy (150) or ultrasonography (200). The accuracy of these methods was related to the following results obtained from hysteroscopy with curettage. RESULTS: The results of the study suggest higher reliability of endometrial biopsy from cytology. The hysteroscopic diagnosis conforms with the histologic examination showed by the curettage. Endometrial cancer as the cause of post-menopausal bleeding can be excluded in cases with endometrial thickness of < or = 5 mm measured by vaginal ultrasonography. CONCLUSIONS: We concluded that the combination of hysteroscopy and endometrial biopsy may substitute for curettage and become the method of choice for the endometrium.     

Correlation of cervical cytology and human papillomavirus DNA detection in postmenopausal women.

This study correlated the cytological features of cervical swabs from postmenopausal women with the histological findings and the detection of human papillomavirus (HPV) using filter hybridization analysis. Of 17 postmenopausal women seen at colposcopy for an abnormal Papanicolaou (Pap) smear, most often squamous atypia, HPV DNA was detected in one (6%) cervical swab. Biopsy-proven cervical squamous intraepithelial lesions (SILs) were noted in two of the 17 (12%). The HPV DNA detection rate was equivalent to that found in 47 postmenopausal women who had hysterectomies for noncervical disease. The rates of HPV detection and biopsy-proven SIL in premenopausal women seen at colposcopy was 55% and 66%, respectively. The HPV DNA detection rate for postmenopausal women with biopsy-proven SILs as determined by in situ hybridization was 19/26 (73%), which is equivalent to the rate in premenopausal women. It is concluded that squamous atypia in postmenopausal women is rarely associated with either biopsy-proven SIL or HPV DNA detection and thus, in many cases, may represent atrophic changes.     

Value of endometrial aspiration cytology in assessing endometrial status

Cytologic findings of endometrial aspiration from 135 women was correlated with pathologic diagnosis of endometrium. The results indicate that different endometrial changes, such as hyperplasia, carcinoma and other malignant endometrial lesions, different phases of normal menstrual cycle and senile atrophy can be distinguished by endometrial cytology. The author suggests that aspiration cytology may serve as a supplement to the biopsy or curettage in the assessment of the status of the endometrium.     

Significance of "normal" endometrial cells in cervical cytology from asymptomatic postmenopausal women receiving hormone replacement therapy

OBJECTIVE: The aim of this study is to assess the significance of normal endometrial cells identified in screening Pap smears from asymptomatic postmenopausal women taking hormone replacement therapy (HRT). METHODS: Endometrial histology reported from 93 asymptomatic postmenopausal women receiving HRT noted to have normal endometrial cells on a screening Pap smear was reviewed. Information regarding HRT, endometrial sampling, and interval between the sentinel Pap and sampling was extracted from the record. RESULTS: Endometrial biopsies were obtained an average of 1.7 months after the Pap smears. Eighteen of the ninety-three histology specimens (19%, 95% CI: 12--27%) identified abnormalities, in four cases precancerous or cancerous lesions. These 18 abnormalities included 7 endometrial polyps; 7 cases of simple hyperplasia, 1 with atypia; 3 cases of complex hyperplasia, 1 with atypia; and 1 endometrial adenocarcinoma. CONCLUSION: Normal endometrial cells identified on a screening Pap smear in this population may be an indication of endometrial disease.     

Peritoneal cytology in patients with endometrial carcinoma

Peritoneal cytology was obtained in 61 patients with carcinoma of the endometrium at the time of laparotomy. The incidence of positive peritoneal cytology was 23.0%. It increased as the clinical stage advanced. The incidence of positive peritoneal cytology in patients with well-differentiated carcinoma or superficial myometrial invasion was low. The rate of paraaortic lymph node metastasis was higher in patients with positive peritoneal cytology than in patients with negative peritoneal cytology. However, this trend was not recognized in pelvic lymph node metastasis. In the positive peritoneal cytology group, 64.3% had disease outside of the uterus, while in the negative group only 12.8%. The 2-year survival rate in patients with positive peritoneal cytology was 57.1% and it was 86.4% in patients with negative peritoneal cytology. It is concluded that the findings of positive peritoneal cytology is an important prognostic factor and routine peritoneal cytology should be obtained at the time of laparotomy in patients with carcinoma of the endometrium.     

绝经后子宫内膜出血的临床病理分析

目的：研究绝经后子宫出血的病因,诊刮子宫内膜的病检及意义。方法：我院85例绝经后子宫出血的患者行诊刮术后子宫内膜组织送病检,标本以中性甲醛液固定,常规行石蜡包埋,HE染色后光镜下划分病理类型,作出结果统计。结采恶性肿瘤8例,腺癌为主;良性病变42例,单纯性增生及子宫内膜炎为主;非器质性病变35例,萎缩性子宫内膜占多数。结论：患者一旦出现绝经后子宫出血,需及时诊刮作病理检查,特别是老年妇女并绝经时间长者,在常规妇检后,须对可疑者行分段刮宫取子宫内膜作病理诊断。     

Prognostic value of peritoneal cytology in endometrial carcinoma

To determine whether positive peritoneal cytology is an independent poor prognostic factor in patients with endometrial carcinoma the records of 381 patients were reviewed. Positive peritoneal cytology was found in 24 of 381 (6.3%) patients. In clinical stage I disease, 16 of 322 (5.0%) patients had positive peritoneal cytology. Patients with positive cytology were more likely to have higher-grade tumors and extrauterine disease at the time of surgery (45% vs 2.3%) than were patients with negative cytology. Five-year survival was significantly less for patients with positive cytology than negative (50% vs 81.2%). For patients with surgical stage I disease (no extrauterine spread at surgery) there was no significant difference in 5-year survival between groups with positive and negative cytology (80% vs 86.3%). The majority (70.8%) of patients with endometrial cancer and positive peritoneal cytology have extrauterine disease at the time of surgery. Although overall 5-year survival is less for patients with positive cytology, when other risk factors are controlled for, there is no difference in survival for patients with no demonstrable extrauterine disease despite positive cytology. We conclude that positive peritoneal cytology is not an independent prognostic indicator for patients with endometrial cancer.     

子宫内膜癌腹腔洗液细胞学检查与预后

目的 探讨腹腔洗液细胞学检查在评价子宫内膜癌患者预后中的价值。方法 对1992年1月～2000年1月我院收治临床分期Ⅰ-Ⅱ期的113例子宫内膜癌患者进行回顾分析及随访。结果 113例子宫内膜癌患者中,腹腔洗液细胞学检查阳性者23例(20.4％),其中4例(17.4％)死于术后复发;90例阴性的患者中,13例(12.56％)死于术后复发,Cox回归分析显示腹腔洗液细胞学检查结果与子宫内膜癌预后相关无显著性(P=0.9516);23例阳性患者中,6例(26％)为不良病理类型,9例(39％)有深肌层浸润,5例(21.7％)宫颈受累,5例(21.7％)有淋巴结转移,Logistic回归多因素分析表明与腹腔洗液细胞学检查阳性有显著相关(P<0.05)。结论 腹腔洗液细胞学检查不能独立作为评价子宫内膜癌患者预后的指标。与腹腔洗液细胞学检查阳性有关的高危因素有不良病理类型、深肌层浸润、宫颈受累和淋巴结转移。     

Ultrasonographic endometrial thickness for diagnosing endometrial pathology in postmenopausal bleeding.

We conducted this retrospective analysis of our clinical data to identify the incidence of benign endometrial abnormalities, endometrial carcinoma and to find out the endometrial thickness (ET) cut-off point using trans-vaginal ultrasonography for patients with postmenopausal bleeding (PMB) referred to the Rapid Access Clinic in Northampton General Hospital. All women referred between April 2004 and April 2005 with PMB were included in this analysis. Final diagnostic outcome was classified into benign endometrial polyp, endometrial hyperplasia, endometrial carcinoma or normal (by excluding these pathologies). A total of 142 patients were included in this survey. The incidence of abnormal endometrial pathology was found to be 23.9% and 5% for endometrial carcinoma. Our results suggested that benign endometrial pathology is the most common cause of postmenopausal bleeding. Lowering the endometrial thickness cut-off point from 5 mm to 3 mm will not improve the diagnostic accuracy of endometrial carcinoma.