Archives of Gynecology and Obstetrics

, Volume 296, Issue 1, pp 99–105 | Cite as

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

  • Xi Yang
  • Ke Ma
  • Rui Chen
  • Jian Zhao
  • Cheng Wu
  • Naiyi Zhang
  • Xiuhua Ma
  • Ying Dong
  • Sainan Zhu
  • Qinping LiaoEmail author
Gynecologic Oncology



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


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.


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%.


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


Screening Endometrial cytology Endometrial precancers Endometrial carcinoma 


Compliance with ethical standards


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.


  1. 1.
    Siegel RL, Miller KD, Jemal A (2015) Cancer statistics, 2015. CA Cancer J Clin 65(1):5–29. doi: 10.3322/caac.21254 CrossRefPubMedGoogle Scholar
  2. 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 CrossRefPubMedGoogle Scholar
  3. 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 CrossRefPubMedGoogle Scholar
  4. 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 CrossRefPubMedGoogle Scholar
  5. 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):882–888PubMedGoogle Scholar
  6. 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 CrossRefGoogle Scholar
  7. 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):34–40CrossRefPubMedGoogle Scholar
  8. 8.
    Buccoliero AM, Resta L, Napoli A, Taddei GL (2009) Liquid-based endometrial cytology: the Florence and Bari experience. Pathologica 101(2):80–84PubMedGoogle Scholar
  9. 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 CrossRefPubMedGoogle Scholar
  10. 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 CrossRefPubMedGoogle Scholar
  11. 11.
    Zhao J (2006) The diagnostic system of endometrial cytology. China J Reprod Health 17:6–8Google Scholar
  12. 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, LyonGoogle Scholar
  13. 13.
    Hao J, Zhao P, Chen WQ (2012) Chinese Cancer Registry annual report. Military Medical Science Press, Beijing, pp 100–101Google Scholar
  14. 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) PubMedGoogle Scholar
  15. 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) CrossRefPubMedGoogle Scholar
  16. 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):1049–1052CrossRefPubMedGoogle Scholar
  17. 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):621–626PubMedGoogle Scholar
  18. 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 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 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):63–69CrossRefPubMedGoogle Scholar
  20. 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):179–184PubMedGoogle Scholar
  21. 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 CrossRefPubMedGoogle Scholar
  22. 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 CrossRefPubMedGoogle Scholar
  23. 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 CrossRefPubMedGoogle Scholar
  24. 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 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung HospitalMedical Center of Tsinghua UniversityBeijingChina
  2. 2.Department of Obstetrics and GynecologyPeking University First HospitalBeijingChina
  3. 3.Department of GynecologyBeijing Cancer HospitalBeijingChina
  4. 4.Department of GynecologyBeijing Daxing District HospitalBeijingChina
  5. 5.Department of PathologyPeking University First HospitalBeijingChina
  6. 6.Department of BiostatisticsPeking University First HospitalBeijingChina

Personalised recommendations