Skip to main content

Liquid-based endometrial cytology associated with curettage in the investigation of endometrial carcinoma in a population of 1987 women

Abstract

Purpose

The aim of this study was to investigate the diagnostic accuracy of liquid-based endometrial cytology, in comparison with histology.

Methods

1987 patients scheduled for hysteroscopy were enrolled in this study. All patients proceeded sequentially through endometrial cytology, hysteroscopy and then dilatation and curettage (D&C). Cytology sampling was performed by brushing the uterus cavity using SAP-1 and the sample was prepared to liquid-based smear using SurePath technology. The slides were stained by Papanicolaou method. All cytological diagnosis was correlated with the D&C histological diagnosis.

Results

Cyto-histological correlations were possible in 1672 (89.3%) patients: in 254 (12.8%) patients the D&C was inadequate, in 75 (3.8%) patients the cytology was inadequate, and in 14 (0.7%) patients both were inadequate. In postmenopausal women, 758 of 790 cytologies (96.0%) were adequate, while 586 of 790 histologies (74.2%) were adequate. SAP-1 provided more sufficient materials for cytology than D&C for histology (P < 0.001). Taking atypical hyperplasia or worse as a positive result, the diagnostic accuracy of liquid-based endometrial cytology was 86.1%, sensitivity was estimated at 70.3%, specificity at 88.5%, positive predictive value at 48.0% and negative predictive value at 95.2%. Taking endometrial carcinoma as a positive result, the diagnostic accuracy of liquid-based endometrial cytology was 94.4%; sensitivity was estimated at 53.2%, specificity at 98.6%, positive predictive value at 79.8% and negative predictive value at 95.3%.

Conclusions

Liquid-based endometrial cytology can be considered a useful method for detecting of endometrial pathology as a first-line approach.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. Siegel RL, Miller KD, Jemal A (2015) Cancer statistics, 2015. CA Cancer J Clin 65(1):5–29. doi:10.3322/caac.21254

    Article  PubMed  Google Scholar 

  2. Odeh M, Vainerovsky I, Grinin V, Kais M, Ophir E, Bornstein J (2007) Three-dimensional endometrial volume and 3-dimensional power Doppler analysis in predicting endometrial carcinoma and hyperplasia. Gynecol Oncol 106(2):348–353. doi:10.1016/j.ygyno.2007.04.021

    CAS  Article  PubMed  Google Scholar 

  3. Yasa C, Dural O, Bastu E, Ugurlucan FG, Nehir A, İyibozkurt AC (2016) Evaluation of the diagnostic role of transvaginal ultrasound measurements of endometrial thickness to detect endometrial malignancy in asymptomatic postmenopausal women. Arch Gynecol Obstet 294(2):311–316. doi:10.1007/s00404-016-4054-5

    Article  PubMed  Google Scholar 

  4. Abdelazim IA, Abdelrazak KM, Elbiaa AA, Al-Kadi M, Yehia AH (2015) Accuracy of endometrial sampling compared to conventional dilatation and curettage in women with abnormal uterine bleeding. Arch Gynecol Obstet 291(5):1121–1126. doi:10.1007/s00404-014-3523-y

    Article  PubMed  Google Scholar 

  5. Garcia F, Barker B, Davis J, Shelton T, Harrigill K, Schalk N, Meyer J, Hatch K (2003) Thin-layer cytology and histopathology in the evaluation of abnormal uterine bleeding. J Reprod Med 48(11):882–888

    PubMed  Google Scholar 

  6. Tsuda H, Nakamura H, Inoue T, Kawamura N, Adachi K, Bandera CA (2005) Transvaginal ultrasonography of the endometrium in postmenopausal Japanese women. Gynecol Obstet Investig 60(4):218–223. doi:10.1159/000087375

    Article  Google Scholar 

  7. Mitchell H, Giles G, Medley G (1993) Accuracy and survival benefit of cytological prediction of endometrial carcinoma on routine cervical smears. Int J Gynecol Pathol 12(1):34–40

    CAS  Article  PubMed  Google Scholar 

  8. Buccoliero AM, Resta L, Napoli A, Taddei GL (2009) Liquid-based endometrial cytology: the Florence and Bari experience. Pathologica 101(2):80–84

    CAS  PubMed  Google Scholar 

  9. Friedlander MA, Rudomina D, Lin O (2008) Effectiveness of the thin prep imaging system in the detection of adenocarcinoma of the gynecologic system. Cancer 114(1):7–12. doi:10.1002/cncr.23257

    Article  PubMed  Google Scholar 

  10. Norimatsu Y, Kouda H, Kobayashi TK, Moriya T, Yanoh K, Tsukayama C, Miyake Y, Ohno E (2008) Utility of thin-layer preparations in the endometrial cytology: evaluation of benign endometrial lesions. Ann Diagn Pathol 12(2):103–111. doi:10.1016/j.anndiagpath.2007.05.005

    Article  PubMed  Google Scholar 

  11. Zhao J (2006) The diagnostic system of endometrial cytology. China J Reprod Health 17:6–8

    Google Scholar 

  12. Tavassoli FA, Devilee P (2003) Tumours of the breast and female genital organs. Pathology and Genetics World Health Organization Classification of Tumours. IARC Press, Lyon

    Google Scholar 

  13. Hao J, Zhao P, Chen WQ (2012) Chinese Cancer Registry annual report. Military Medical Science Press, Beijing, pp 100–101

    Google Scholar 

  14. Tabor A, Watt HC, Wald NJ (2002) Endometrial thickness as a test for endometrial cancer in women with postmenopausal vaginal bleeding. Obstet Gynecol 99(4):663–670 (pii: S0029784401017719)

    PubMed  Google Scholar 

  15. Gull B, Karlsson B, Milsom I, Granberg S (2003) Can ultrasound replace dilation and curettage? A longitudinal evaluation of postmenopausal bleeding and transvaginal sonographic measurement of the endometrium as predictors of endometrial cancer. Am J Obstet Gynecol 188(2):401–408 (pii: S0002937802714841)

    CAS  Article  PubMed  Google Scholar 

  16. Yarandi F, Izadi-Mood N, Eftekhar Z, Shojaei H, Sarmadi S (2010) Diagnostic accuracy of dilatation and curettage for abnormal uterine bleeding. J Obstet Gynaecol Res. 36(5):1049–1052

    Article  PubMed  Google Scholar 

  17. Mossa B, Ebano V, Marziani R (2010) Reliability of outpatient endometrial brush cytology vs biopsy in postmenopausal symptomatic women. Eur J Gynaecol Oncol 31(6):621–626

    CAS  PubMed  Google Scholar 

  18. Yanoh K, Norimatsu Y, Hirai Y, Takeshima N, Kamimori A, Nakamura Y, Shimizu K, Kobayashi TK, Murata T, Shiraishi T (2009) New diagnostic reporting format for endometrial cytology based on cytoarchitectural criteria. Cytopathology 20(6):388–394. doi:10.1111/j.1365-2303.2008.00581.x

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  19. Kyroudi A, Paefthimiou M, Symiakaki H, Mentzelopoulou P, Voulgaris Z, Karakitsos P (2006) Increasing diagnostic accuracy with a cell block preparation from thin-layer endometrial cytology: a feasibility study. Acta Cytol 50(1):63–69

    Article  PubMed  Google Scholar 

  20. Buccoliero AM, Caldarella A, Noci I, Borri P, Giachi M, Borrani E, Taddei GL (2003) Thin-layer cytology in endometrial diagnosis. Pathologica 95(4):179–184

    CAS  PubMed  Google Scholar 

  21. Buccoliero AM, Gheri CF, Castiglione F, Garbini F, Barbetti A, Fambrini M, Bargelli G, Pappalardo S, Taddei A, Boddi V, Scarselli GF, Marchionni M, Taddei GL (2007) Liquid-based endometrial cytology: cyto-histological correlation in a population of 917 women. Cytopathology 18(4):241–249. doi:10.1111/j.1365-2303.2007.00463.x

    CAS  Article  PubMed  Google Scholar 

  22. Buccoliero AM, Castiglione F, Gheri CF, Garbini F, Fambrini M, Bargelli G, Pappalardo S, Scarselli G, Marchionni M, Taddei GL (2007) Liquid-based endometrial cytology: its possible value in postmenopausal asymptomatic women. Int J Gynecol Cancer 17:182–187. doi:10.1111/j.1525-1438.2006.00757.x

    CAS  Article  PubMed  Google Scholar 

  23. Yanoh K, Hirai Y, Sakamoto A, Aoki D, Moriya T, Hiura M, Yamawaki T, Shimizu K, Nakayama H, Sasaki H, Tabata T, Ueda M, Udagawa Y, Norimatsu Y (2012) New terminology for intrauterine endometrial samples: a group study by the Japanese Society of Clinical Cytology. Acta Cytol 56(3):233–241. doi:10.1159/000336258

    Article  PubMed  Google Scholar 

  24. Norimatsu Y, Miyamoto M, Kobayashi TK, Moriya T, Shimizu K, Yanoh K, Tsukayama C, Miyake Y, Ohno E (2008) Diagnostic utility of phosphatase and tensin homolog, beta-catenin, and p53 for endometrial carcinoma by thin-layer endometrial preparations. Cancer 114(3):155–164. doi:10.1002/cncr.23495

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Qinping Liao.

Ethics declarations

Funding

There are no funding or financial disclosures for the work.

Ethical standards

The protocol of the study was approved by the Institutional Review Board of the Peking University First Hospital.

Conflict of interest

The authors have no conflicts of interest relevant to this article.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yang, X., Ma, K., Chen, R. et al. Liquid-based endometrial cytology associated with curettage in the investigation of endometrial carcinoma in a population of 1987 women. Arch Gynecol Obstet 296, 99–105 (2017). https://doi.org/10.1007/s00404-017-4400-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-017-4400-2

Keywords

  • Screening
  • Endometrial cytology
  • Endometrial precancers
  • Endometrial carcinoma