Liquid fixation of endometrial brush cytology ensures a well-preserved, representative cell sample with frequent tissue correlation.

Endometrium was obtained by brushing 656 hysterectomy specimens with a MedScand cytobrush (Hollywood, FL) in order to evaluate linking an easy-to-use liquid fixative with brush-sampling of the endometrium, and to determine the fixative's operating characteristics when applied to brush-sampling the endometrium. Liquid-fixed brush-samples yielded 4 to 6 slides per case, and any one slide accurately represented the case diagnosis. Tissue fragments were incidentally collected by the brush in 524 cases (79.9%), were least often obtained from senile and weakly proliferative endometria, and were always obtained from high-grade endometrial hyperplasias and carcinomas. With tissue fragments obtained by brush-sampling, the diagnosis matched that of the hysterectomy endometrium. Cytology alone separated benign endometrium from high-grade atypical hyperplasia and carcinoma, showing that clinical decision-making can be based on endometrial brush cytology collected into a liquid fixative. Furthermore, the addition of tissue-fragment histology increased the diagnostic accuracy of the endometrial brushing procedure to 92.5% overall and 100% for high-grade atypical hyperplasias and carcinomas. At this juncture, we advocate endometrial brushing as a sensitive and generally specific case-finding technique; and perhaps as experience teaches us to distinguish low-grade nonatypical hyperplasias from purely physiological changes of the endometrium, it may become accepted as a definitive diagnostic method. The advantages of examining a liquid-fixed suspension are that 1) because these preparations are homogeneous from slide to slide, with any one slide affording the same diagnosis as any other slide from the same case, the number of slides examined may be greatly reduced, and 2) tissue fragments can be used to quality-control the cytology diagnosis in the majority of cases, especially in cases of endometrial hyperplasia and carcinoma.