Remondi C, Sesti F, Bonanno E, Pietropolli A, Piccione E
Section of Gynecology, Academic Department of Biomedicine & Prevention and Clinical Department of Surgery, Tor Vergata University Hospital, Rome, ItalyAnatomic Pathology Institute, Department of Biomedicine & Prevention, School of Medicine, Tor Vergata University Hospital, Rome, Italy.
Cytopathology. 2013 Dec;24(6):365-71. doi: 10.1111/cyt.12013. Epub 2012 Sep 21.
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.
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.
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.
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.
本研究旨在比较液基子宫内膜细胞学检查与宫腔镜检查及子宫内膜活检在一系列绝经后异常子宫出血（AUB）妇女或经阴道超声评估为子宫内膜增厚的无症状妇女中的诊断准确性，将经阴道超声作为一种筛查方法。
纳入标准为：绝经状态；存在AUB和/或经超声评估子宫内膜增厚（临界值4mm）；巴氏涂片正常；超声检查无附件病变。排除标准为：既往有子宫内膜病变；既往有宫腔镜手术史。在转诊至我们普通妇科门诊的768名绝经后妇女中，121名符合纳入标准并被纳入试验。21名拒绝参与。使用Endoflower装置在不扩张宫颈的情况下刷取宫腔进行细胞学采样，样本瓶使用ThinPrep® 2000自动玻片处理仪进行处理。玻片采用巴氏染色法染色。
在98例进行组织活检的病例中，子宫内膜细胞学检查发现5例子宫内膜癌、10例非典型增生和47例非非典型增生；36例为阴性。2例因宫颈狭窄细胞学检查不充分。以非典型增生或更严重病变为阳性检测结果，子宫内膜细胞学检查的诊断准确性为93.5%，敏感性为92%，特异性为95%，阳性预测值为73%，阴性预测值为99%。所有癌症均通过细胞学检查检测到。诊断为阳性的妇女中只有42%有症状。所有患者对细胞学采样耐受性良好。未记录到并发症。
液基子宫内膜细胞学检查可被视为检测子宫内膜病变的一种有用的诊断方法，作为一线方法，特别是与经阴道超声联合使用时。
