Endometrial cytology: Six years of experience

Abstract

This article deals with a 6-yr mass screening program for the early detection of endometrial cancer, which took place 1978-1983. The diagnostic accuracy of endometrial cytology and the possibility of integrating this technique with the hysteroscopy and endometrial biopsy were studied. The authors analyzed 2,504 outpatients, all over the age of 45. The results of endometrial cytology were compared with those found using hysteroscopy and endometrial biopsy. Endometrial cytology showed high sensitivity in diagnosing endometrial cancer (97.7%) and high specificity in diagnosing true negatives. However, this technique was not adequate in identifying benign endometrial pathology, e.g., endometrial hyperplasia, polyps, or submucous fibromas. Epidemiological and clinical data in our series were fundamental in establishing mass screening for the early detection of endometrial cancer using integrated techniques. These data should be taken into consideration for creating new projects. The significantly high prevalence of endometrial neoplasia even in asymptomatic women over 45 years of age (4 per 1000) and the possibility of improving the accuracy of endometrial diagnosis using hysteroscopy and endometrial biopsy were the cornerstones of this project.

Immunocytodiagnosis of atypical hyperplasia and endometrial carcinoma in post‐menopausal women

“…The new plastic brush "endocyte" sampling device provides a fast and simple method of obtaining specimens of good quality in about 80% of cases, with minimum trauma for the patient (Ferenczy and Gelfand, 1984). Despite this improvement, cytodiagnosis from these specimens lacks accuracy, especially in differentiating dysfunctional pathology of the endometrium, particularly hyperplastic lesions (Ferenczy and Gelfand, 1984;Mencaglia, 1987;Kashimura et al, 1988). This has raised the question whether the use of MAbs, identifying well-characterized TAA, may improve the current performance of endometrial cytodiagnosis, allowing more accurate screening of symptomatic and highrisk asymptomatic post-menopausal women.…”

“…This is likely to be due to the well-known influence that hormonal status, previous diagnostic procedures and intrauterine contraceptive devices (Kashimura et al, 1988) may have on the endometrial morphology. Furthermore, about 50% of the patients with ongoing uterine bleeding have no detectable pathological lesions of the endometrium, and thus require more extensive diagnostic procedures (Mencaglia, 1987). The results of this immunocytochemical testing have shown that MAbs AR-3 and B72.3, although not able to discriminate between hyperplasia and endometrial carcinoma, may represent a useful adjunct to endometrial cytology complementing conventional morphology in (1) identifying those endometrial atypical hyperplastic lesions which have been epidemiologically identified as precursors of carcinoma (Kurman and Norris, 1982;Kurman et al, 1985;Ferenczy and Gelfand, 1989), and (2) defining, on the basis of the antigenic phenotype, the malignant nature of those endometrial lesions with uncertain cytological aspects.…”

“…Despite this technical improvement, which may identify precursor lesions of endometrial carcinoma, especially in high-risk post-menopausal women (Koss et al, 1982), the morphological interpretation of endometrial cytology still remains highly subjective and often inadequate in detecting some pre-neoplastic conditions such as atypical hyperplasia (Mencaglia, 1987). In this context, the increasing characterization of MAbs recognizing different tumor-associated antigens (TAA) may offer-as in other areas of cytopathology (Johnston et al, 1985; Mottolese et al, 1989)-a more sensitive and objective diagnostic method.…”

“…lmmunocytochernical (ICC) tests, using the 2 reagents, were performed on normal cycling endometrium and on hyperplastic and malignant lesions collected by the endocyte technique both from 86 surgically resected specimens and from 62 postmenopausal symptomatic and asymptomatic outpa- The failure of routine cytology performed on cervical smears to effectively detect endometrial carcinoma (Burk et al, 1974) has led to the development of direct endometrial sampling techniques which could provide better diagnostic accuracy (Ferenczy and Gelfand, 1984). Despite this technical improvement, which may identify precursor lesions of endometrial carcinoma, especially in high-risk post-menopausal women (Koss et al, 1982), the morphological interpretation of endometrial cytology still remains highly subjective and often inadequate in detecting some pre-neoplastic conditions such as atypical hyperplasia (Mencaglia, 1987). In this context, the increasing characterization of MAbs recognizing different tumor-associated antigens (TAA) may offer-as in other areas of cytopathology (Johnston et al, 1985;Mottolese et al, 1989)-a more sensitive and objective diagnostic method.…”

Diffuse Endocrine System (DES) Cells of the Uterus Endometrium of Intact Rats in Different Phases of the Estrous Cycle

“…Одной из главных задач совре-менной онкогинекологии является изучение раз-личных аспектов патогенеза предраковых процес-сов [12] и рака шейки матки [10]. Клетки диффуз-ной эндокринной системы участвуют в физиологи-ческих процессах, которые протекают циклически в матке: овариально-менструальный цикл у женщин и эстральный цикл у животных [2,7].…”