Cytological Scoring and Prognosis of Poorly Differentiated Endometrioid Adenocarcinoma

Abstract

Objective: Histopathological variation has been demonstrated in grade 3 endometrioid adenocarcinomas. We attempted to evaluate the clinicopathological features of grade 3 tumors by endometrial cytological features using a scoring system. Study Design: Twenty-one endometrial cytological samples were evaluated using 5 cytological features: rates of cluster formation in tumor cells; nuclear pleomorphism; nuclear dimension; size of nucleoli, and chromatin structure and distribution. The relationships between cytological scores and clinicopathological factors or prognosis were investigated. Results: The median cytological score was 6 (range 4-14); therefore, samples with scores of 4-5 were defined as having low scores, while those with scores of 6-14 were defined as high scores. The accuracy of the cytological diagnosis for grade 3 tumors in the high score group (8/10 patients, 80.0%) was significantly higher than that of the low score group (2/11 patients, 18.2%; p = 0.009). Significant relationships between cytological scores and lymph node metastases or positive peritoneal cytology were observed (p = 0.03 and 0.035, respectively). The overall survival rate was significantly worse in the high score group (30.0%) than the low score group (88.9%; p = 0.02). Conclusions: Grade 3 endometrioid adenocarcinomas varied in cytological features; according to the scoring system used, high scores were associated with worse clinicopathological factors and poorer prognosis than low scores.

Nuclear morphometry as an adjunct to cytopathologic examination of endometrial brushings on LBC samples: A prospective approach to combined evaluation in endometrial neoplasms and look alikes

“…Several diagnostic criteria systems [3][4][5][6] In our study, various nuclear findings were examined by image morphometry ( and Kato 5 and were approximately similar to those used at the time of histological diagnosis. 16,19 Furthermore, it was confirmed that the same four criteria (nuclear enlargement, anisonucleosis, nuclear shade, and nucleolar size) evaluated by our group using image morphometry are equally valuable for the cytohistological differential diagnosis between LG-EC and HG-EC.…”

“…In several studies evaluating endometrial cytology, the criteria for objective evaluation of nuclear atypia are as follows: evaluation of the nuclear area and nuclear roundness, nuclear pleomorphism (anisonucleosis), nuclear size, chromatin structure and distribution, size of nucleoli, and mitoses. [3][4][5][6] As observed with other grading systems, however, the assessment of nuclear atypia is highly subjective in the FIGO histologic grading. 7 Reportedly, Lax et al 8 have presented an interobserver agreement of 35% (0.22), while Sagae 9 showed a 49% agreement (0.23).…”

“…Therefore, the introduction of an objective methodology for the assessment of nuclear features is considered necessary to distinguish between benign and malignant disease [11][12][13] or between LG-EC and HG-EC. [3][4][5][6] In this study, we aimed to retrospectively investigate and confirm whether atypical nuclear findings determined by image morphometry in LBC endometrial cytology are useful when compared with microscopic evaluation.…”

Comparison of cytological and immunocytochemical methods for detecting apoptotic epithelial cells in cervicovaginal smears

“…Various scoring systems were used for tumor grading and differentiation of atypical cells from normal cells, as well as quantification of immunocytochemical staining (H‐score) . Cytological scores were widely used in the evaluation of endometrial biopsies, and fine‐needle aspirates of thyroid, breast, and lung tissues . To our knowledge, our scoring system is the first system evaluating apoptosis by using Pap smears.…”

Positive Peritoneal Cytology as a Predictor of Prognosis in Early Stage of Endometrioid Adenocarcinoma

“…Others believed that malignant peritoneal cytology is an indicator of aggressive tumor behavior rather than disease spread through peritoneal space (33,36). On the other hand, the majority of studies have shown the association between malignant cytology and other adverse prognostic features such as high grade disease, non-endometrioid histology, and deep myometrial invasion (30,(37)(38)(39).…”