Diagnostic accuracy of liquid-based endometrial cytology in the evaluation of endometrial pathology in postmenopausal women

Authors

  • C. Remondi,

    1. Section of Gynecology, Academic Department of Biomedicine & Prevention and Clinical Department of Surgery, Tor Vergata University Hospital, Rome, Italy
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  • F. Sesti,

    1. Section of Gynecology, Academic Department of Biomedicine & Prevention and Clinical Department of Surgery, Tor Vergata University Hospital, Rome, Italy
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  • E. Bonanno,

    1. Anatomic Pathology Institute, Department of Biomedicine & Prevention, School of Medicine, Tor Vergata University Hospital, Rome, Italy
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  • A. Pietropolli,

    1. Section of Gynecology, Academic Department of Biomedicine & Prevention and Clinical Department of Surgery, Tor Vergata University Hospital, Rome, Italy
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  • E. Piccione

    1. Section of Gynecology, Academic Department of Biomedicine & Prevention and Clinical Department of Surgery, Tor Vergata University Hospital, Rome, Italy
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F. Sesti, School of Medicine, Academic Department of Biomedicine & Prevention and Clinical Department of Surgery, Section of Gynecology, Tor Vergata University Hospital, Viale Oxford 81, 00133 Rome, Italy
Tel./fax: +39 06 20 902 921;
E-mail:francesco.sesti@uniroma2.it

Abstract

C. Remondi, F. Sesti, E. Bonanno, A. Pietropolli and E. Piccione
Diagnostic accuracy of liquid-based endometrial cytology cytology in the evaluation of endometrial pathology in postmenopausal women

Objective:  The aim of this study was to compare liquid-based endometrial cytology with hysteroscopy and endometrial biopsy regarding its diagnostic accuracy in a series of postmenopausal women with abnormal uterine bleeding (AUB) or asymptomatic women with thickened endometrium assessed by transvaginal ultrasound as a screening procedure.

Methods:  Inclusion criteria were: menopausal status; the presence of AUB and/or thickened endometrium assessed by ultrasound (cut-off 4 mm); a normal Papanicolaou (Pap) smear; and no adnexal pathology at ultrasound. Exclusion criteria were: previous endometrial pathology; and previous operative hysteroscopy. Of 768 postmenopausal women referred to our general gynaecology clinics, 121 fulfilled the inclusion criteria and were recruited to the trial. Twenty-one refused to participate. Cytological sampling was carried out by brushing the uterine cavity using the Endoflower device with no cervical dilation and the vial was processed using a ThinPrep® 2000 automated slide processor. The slides were stained using a Pap method.

Results:  In 98 cases with histological biopsies, endometrial cytology detected five cases of endometrial carcinoma, 10 of atypical hyperplasia and 47 of non-atypical hyperplasia; 36 cases were negative. In two cases cytology was inadequate because of uterine cervical stenosis. Taking atypical hyperplasia or worse as a positive test and outcome, the diagnostic accuracy of the endometrial cytology was 93.5%, with a sensitivity of 92% and specificity of 95%, a positive predictive value of 73% and a negative predictive value of 99%. All the carcinomas were detected by cytology. Only 42% of women with a positive diagnosis were symptomatic. The cytological sampling was well tolerated by all patients. No complication was registered.

Conclusions:  Liquid-based endometrial cytology can be considered an useful diagnostic method in the detection of endometrial pathology as a first-line approach, particularly if associated with transvaginal ultrasound.

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