Brush Cytology of the Fallopian Tube and Implications in Ovarian Cancer Screening

A novel hysteroscopic approach for ovarian cancer screening/early diagnosis

“…Following a systematic review of the literature, it was identified that only a single manuscript proposed a novel approach for the screening/early diagnosis of EOC; this study had a positive rationale as the authors focused the proposal and pilot study on the 'brush cytology of the fallopian tube' (19). Lum et al (19) proposed cytological sampling of the fallopian tube [analogous to the Papanicolaou test (7) for the uterine cervix] to collect endoluminal cells, allowing for discrimination between negative samples and those containing cells suggestive of serous tubal intraepithelial carcinoma, which may be the initial precursor of type II EOC.…”

“…Lum et al (19) proposed cytological sampling of the fallopian tube [analogous to the Papanicolaou test (7) for the uterine cervix] to collect endoluminal cells, allowing for discrimination between negative samples and those containing cells suggestive of serous tubal intraepithelial carcinoma, which may be the initial precursor of type II EOC. In the opinion of the authors of the present study, despite the fact that this protocol was unique in its rationale, it may comprehensibly considered only a theoretical proposal due to the presence of several important biases responsible for yielding disappointing results, as well as poor feasibility and reproducibility in a large scale population.…”

“…In the opinion of the authors of the present study, despite the fact that this protocol was unique in its rationale, it may comprehensibly considered only a theoretical proposal due to the presence of several important biases responsible for yielding disappointing results, as well as poor feasibility and reproducibility in a large scale population. The small number of patients (n=10) on which the procedures were performed in addition to the inappropriate eligibility criteria for patient selection made the pilot study useful only for the technical validation of procedure feasibility (all specimens had satisfactory cellularity for interpretation without any complications linked to the procedure), as all cases were interpreted as benign in morphological and immunohistochemical investigations (19). Furthermore, the study failed to demonstrate procedure feasibility due to the erroneous choice of the cervical cytobrush for tubal cytological sampling, which affected the study protocol for at least 3 reasons: i) The diameter and slight flexibility of the cytobrush device does not allow cytological sampling in the infundibulum and fimbriae (in which precursor cells of EOC frequently originate); ii) the mechanical trauma caused by the brush may adversely affect the subsequent histopathological analysis of the tubal epithelium, particularly in situations where the tumor is intraepithelial and the aggregates of the atypical cells are few; and iii) intra-tubal traumatic sampling may irreversibly damage the fallopian tube epithelium, causing a negative impact on functioning (physiologically defined as the ability to convey the products of conception to the uterus).…”

“…Beginning from the innovative and intuitive study by Lum et al (19), the present study protocol is proposed, with the aim of validating the rationale, usefulness and feasibility of a non-invasive outpatient hysteroscopic approach (known as 'Tuba-check') in the assessment of tubal lumen cell abnormalities. This strategy may potentially be eligible as a screening/early diagnostic tool in patients at increased risk of EOC development.…”

Design of an everting balloon to deploy a microendoscope to the fallopian tubes

“…A recent study to gather dysplastic cells was performed on the fallopian tubes of women undergoing laparoscopic hysterectomy. [7] This study used a 3.2 Fr (1 mm) brush for hysteroscopic cytology and a 5 Fr brush for laparoscopic sampling, but could only reach approximately 3 cm into the proximal end. [8] Perhaps the first attempt to image the lumen of the fallopian tube from a proximal introduction for cancer in vivo was performed with a forwardviewing scanning fiber endoscope.…”