Yanoh K, Norimatsu Y, Hirai Y, Takeshima N, Kamimori A, Nakamura Y, Shimizu K, Kobayashi T K, Murata T, Shiraishi T
Department of Gynaecology, Suzuka General Hospital, Mie 513-8630, Japan.
Cytopathology. 2009 Dec;20(6):388-94. doi: 10.1111/j.1365-2303.2008.00581.x. Epub 2008 Jul 24.
The aim of this study was to develop a new reporting format for endometrial cytology that would standardize the diagnostic criteria and the terminology used for reporting.
In previous studies, cytoarchitectural criteria were found to be useful for the cytological assessment of endometrial lesions. To apply these criteria, an appropriate cytological specimen is imperative. In this article, the requirements of an adequate endometrial cytological specimen for the new diagnostic criteria are first discussed. Then, the diagnostic criteria, standardized on a combination of conventional and cytoarchitectural criteria, are presented. Third, terminology that could be used, not only for reporting the histopathological diagnosis, but also for providing better guidance for the gynaecologist to determine further clinical action, is introduced. The proposed reporting format was investigated using endometrial cytology of 58 cases that were cytologically underestimated or overestimated compared to the histopathological diagnosis made on the subsequent endometrial biopsy or surgical specimens.
Of the 58 cases, 12 were reassessed as being unsatisfactory for evaluation. Among the remaining 46 cases, 25 of the 27 cases, which had been underestimated and subsequently diagnosed as having endometrial carcinoma or a precursor stage on histopathological examination,were reassessed as recommended for endometrial biopsy. On the other hand, 19 cases overestimated by cytology were all reassessed as not requiring biopsy.
The reporting format for endometrial cytology proposed in this article may improve diagnostic accuracy and reduce the number of patients managed inappropriately.
本研究旨在开发一种新的子宫内膜细胞学报告格式，以规范诊断标准和报告中使用的术语。
在先前的研究中，发现细胞结构标准对子宫内膜病变的细胞学评估有用。为应用这些标准，合适的细胞学标本必不可少。本文首先讨论了符合新诊断标准的充足子宫内膜细胞学标本的要求。然后，提出了基于传统标准和细胞结构标准相结合的诊断标准。第三，引入了不仅可用于报告组织病理学诊断，还可为妇科医生确定进一步临床行动提供更好指导的术语。使用58例子宫内膜细胞学病例对所提议的报告格式进行了研究，这些病例与后续子宫内膜活检或手术标本的组织病理学诊断相比，在细胞学上被低估或高估。
58例病例中，12例被重新评估为不适合评估。在其余46例病例中，27例被低估且随后在组织病理学检查中被诊断为子宫内膜癌或癌前阶段的病例中，有25例根据建议被重新评估为需要进行子宫内膜活检。另一方面，19例在细胞学上被高估的病例均被重新评估为不需要活检。
本文提出的子宫内膜细胞学报告格式可能会提高诊断准确性，并减少处理不当的患者数量。
