1
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Yang X, Ma K, Chen R, Meng YT, Wen J, Zhang QQ, Zhu J, Yang JK, Zhao XL, Huang X, Zhang L, Lv T, Liao Q. A study evaluating liquid-based endometrial cytology test and transvaginal ultrasonography as a screening tool for endometrial cancer in 570 postmenopausal women. J Gynecol Obstet Hum Reprod 2023; 52:102643. [PMID: 37558050 DOI: 10.1016/j.jogoh.2023.102643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 04/05/2022] [Accepted: 08/06/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE To evaluate the combination of transvaginal ultrasonography (TVS) and endometrial cytology test (ECT) as a potential diagnostic strategy for endometrial cancer and endometrial precancerous lesions in postmenopausal patients. METHODS 570 postmenopausal patients admitted in our hospital due to abnormal bleeding or other symptoms and/or with endometrium thickness over 5 mm on ultrasound. The endometrial thickness was evaluated by TVS. Following obtainment with written consent, all patients underwent ECT, hysteroscopy and then dilatation and curettage (D&C). Cytological sampling was conducted by scratching the uterus cavity using SAP-1 and the samples were prepared as liquid-based smear using SurePath technology. The samples were stained using Papanicolaou method. The correlation between cytological diagnosis and TVS results with the D&C histological diagnosis was analyzed. The WHO classification was used for diagnosis. RESULTS Sensitivity of ECT, TVS, ECT or TVS positive, ECT and TVS positive to diagnose atypical hyperplasia or worse were estimated at 80.7%, 86.8%, 97.4%, 70.2%, specificity at 94.7%, 20.4%, 17.5%, 88.4%, positive predictive value at 58.2%, 21.1%, 22.8%, 60.2%, negative predictive value at 94.4%, 86.1%, 96.4%, 92.2%, and accuracy at 84.6%, 33.7%, 33.5%, 84.7%, respectively. CONCLUSIONS Transvaginal ultrasonography and Endometrial cytology test may be regarded as a effective first-line method in endometrial pathology detection in postmenopausal women.
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Affiliation(s)
- Xi Yang
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Medical Center of Tsinghua University, Beijing, China; Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Ke Ma
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Medical Center of Tsinghua University, Beijing, China; Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Rui Chen
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Medical Center of Tsinghua University, Beijing, China; Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Yi-Ting Meng
- Department of Pathology, Beijing Tsinghua Changgung Hospital, Medical Center of Tsinghua University, Beijing, China
| | - Jia Wen
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Medical Center of Tsinghua University, Beijing, China
| | - Qiong-Qiong Zhang
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Medical Center of Tsinghua University, Beijing, China
| | - Jie Zhu
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Medical Center of Tsinghua University, Beijing, China
| | - Jing-Kun Yang
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Medical Center of Tsinghua University, Beijing, China
| | - Xiu-Lian Zhao
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Medical Center of Tsinghua University, Beijing, China
| | - Xin Huang
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Medical Center of Tsinghua University, Beijing, China
| | - Lei Zhang
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Medical Center of Tsinghua University, Beijing, China
| | - Tao Lv
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Medical Center of Tsinghua University, Beijing, China
| | - Qinping Liao
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Medical Center of Tsinghua University, Beijing, China; Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.
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2
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O'Flynn H, Jones E, Njoku K, Rana D, Shelton D, Narine N, Ramchander NC, Patel V, Walter FM, Walsh T, Crosbie EJ. Cytology for the diagnosis of endometrial cancer in symptomatic women. Hippokratia 2021. [DOI: 10.1002/14651858.cd014560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Helena O'Flynn
- Division of Cancer Sciences; Faculty of Biology, Medicine and Health, The University of Manchester; Manchester UK
| | - Eleanor Jones
- Division of Cancer Sciences; Faculty of Biology, Medicine and Health, The University of Manchester ; Manchester UK
| | - Kelechi Njoku
- Division of Cancer Sciences; Faculty of Biology, Medicine and Health, The University of Manchester; Manchester UK
| | - Durgesh Rana
- Cytopathology; Manchester University Foundation Trust ; Manchester UK
| | - David Shelton
- Cytopathology; Manchester University Foundation Trust ; Manchester UK
| | - Nadira Narine
- Cytopathology; Manchester University Foundation Trust ; Manchester UK
| | - Neal C Ramchander
- Division of Cancer Sciences; Faculty of Biology, Medicine and Health, The University of Manchester; Manchester UK
| | - Vaishali Patel
- Division of Cancer Sciences; Faculty of Biology, Medicine and Health, The University of Manchester; Manchester UK
| | - Fiona M Walter
- Public Health & Primary Care; University of Cambridge; Cambridge UK
| | - Tanya Walsh
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health; The University of Manchester; Manchester UK
| | - Emma J Crosbie
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health; The University of Manchester; Manchester UK
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3
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Zhang Y, Zhao Y, Lang JH, Li Y. ES Sampler, a minimally invasive endometrial sampling tool that obtains specimens suitable for both cytological and histological analysis. J Obstet Gynaecol Res 2021; 47:1854-1861. [PMID: 33590599 DOI: 10.1111/jog.14697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/03/2021] [Accepted: 01/29/2021] [Indexed: 11/29/2022]
Abstract
AIM Conventional endometrial examination by dilatation and curettage (D&C) is not accepted by many patients because it is associated with pain and risk of injury and typically requires anesthesia and hospitalization. While several less invasive endometrial screening tools have been developed, their diagnostic value is generally inferior to D&C. Therefore, the purpose of this study was to evaluate the effectiveness of a new, minimally invasive device, called the ES Sampler, for outpatient endometrial screening. METHODS This was a single-blind study of 96 patients (age: 36.8 ± 8.1 years) who attended Peking Union Medical College Hospital from March 2015 to August 2016. Specimens were collected from each participant using the ES Sampler, followed by traditional D&C by hysteroscopy, and evaluated by histology and/or cytology. The sampling adequacy, sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy were compared, and patient acceptability was assessed. RESULTS Compared to traditional D&C, the ES Sampler exhibited 99.0% sampling adequacy, and the combined (histology and cytology) results demonstrated 88.9% sensitivity, 95.6% specificity, 88.9% positive predictive value, 95.6% negative predictive value, and 93.7% accuracy. Moreover, the majority of study participants reported mild or no pain associated with the ES Sampler, and blood loss was minimal. CONCLUSIONS Our findings suggest that the minimally invasive ES Sampler is a reliable and accurate endometrial screening tool that is easily accepted by patients. The ES Sampler could be useful for screening high-risk patients who may need further, more invasive examination, thereby conserving medical resources and minimizing patient discomfort.
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Affiliation(s)
- Yinglan Zhang
- Department of Gynecology and Obstetrics, Beijing Chaoyang Hospital, Beijing, China
| | - Yu Zhao
- Department of Pathology in Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Jing He Lang
- Department of Gynecology and Obstetrics of Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Yuan Li
- Department of Gynecology and Obstetrics, Beijing Chaoyang Hospital, Beijing, China
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4
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Wang Q, Wang Q, Zhao L, Han L, Sun C, Ma S, Hou H, Song Q, Li Q. Endometrial Cytology as a Method to Improve the Accuracy of Diagnosis of Endometrial Cancer: Case Report and Meta-Analysis. Front Oncol 2019; 9:256. [PMID: 31069167 PMCID: PMC6491702 DOI: 10.3389/fonc.2019.00256] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 03/21/2019] [Indexed: 12/16/2022] Open
Abstract
More and more researchers have reported that dilatation and curettage (D&C) or Pipelle had low accuracy, high misdiagnosis, and insufficient rate. Endometrial cytology is often compared with histology and seems to be an efficient method for the diagnosis of endometrial disorders, especially endometrial cancer. We report a case of misdiagnosed endometrial cancer by D&C, but with a positive cytopathological finding. Following that, a meta-analysis including 4,179 patients of endometrial diseases with cyto-histopathological results was performed to assess the value of the endometrial cytological method in endometrial cancer diagnosis. The pooled sensitivity and specificity of the cytological method in detecting endometrial atypical hyperplasia or cancer was 0.91[95% confidence interval (CI) 0.74–0.97] and 0.96 (95% CI 0.90–0.99), respectively. The pooled positive likelihood ratio and negative likelihood ratio was 25.4 (95% CI 8.1–80.1) and 0.10 (95% CI 0.00–0.30), respectively. The diagnostic odds ratio which was usually used to evaluate the diagnostic test performance reached 260 (95% CI 36–1905). So we recommend that D&C and Pipelle are still practical procedures to evaluate the endometrium, cytological examinations should be utilized as an additional endometrial assessment method.
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Affiliation(s)
- Qing Wang
- Center for Single-Cell Biology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.,Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Qi Wang
- Center for Single-Cell Biology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.,Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Lanbo Zhao
- Guipei 77, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Lu Han
- Center for Single-Cell Biology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.,Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Chao Sun
- Center for Single-Cell Biology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.,Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Sijia Ma
- Center for Single-Cell Biology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.,Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Huilian Hou
- Department of Pathology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Qing Song
- Center for Single-Cell Biology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Qiling Li
- Center for Single-Cell Biology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.,Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
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Hirai Y, Sakamoto K, Fujiwara H, Kamata M, Tamura T, Yanoh K, Norimatsu Y, Kasai T, Teramoto K, Kurokawa T, Takahashi Y, Iwanari O, Suzuki M. Liquid‐based endometrial cytology using SurePath™ is not inferior to suction endometrial tissue biopsy for detecting endometrial malignancies: Midterm report of a multicentre study advocated by Japan Association of Obstetricians and Gynecologists. Cytopathology 2019; 30:223-228. [DOI: 10.1111/cyt.12657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 09/29/2018] [Indexed: 01/16/2023]
Affiliation(s)
- Yasuo Hirai
- PCL Japan Pathology and Cytology Center PCL Inc. Saitama Japan
- Department of Obstetrics and Gynecology Faculty of Medicine Dokkyo Medical University Tochigi Japan
| | - Kimihiko Sakamoto
- Department of Obstetrics and Gynecology NTT Medical Center Tokyo Tokyo Japan
| | - Hiroyuki Fujiwara
- Department of Obstetrics and Gynecology Jichi Medical University Tochigi Japan
| | - Masaharu Kamata
- Department of Obstetrics and Gynecology Mutual Aid Association of Public School Teachers Shikoku Central Hospital Shikokuchuou UK
| | - Takao Tamura
- Department of Obstetrics and Gynecology Mutual Aid Association of Public School Teachers Shikoku Central Hospital Shikokuchuou UK
| | - Kenji Yanoh
- Department of Obstetrics and Gynecology JA Suzuka General Hospital Suzuka Mie Japan
| | - Yoshiaki Norimatsu
- Department of Medical Technology Faculty of Health Sciences Ehime Prefectural University of Health Sciences Ehime Japan
| | - Tokuzo Kasai
- Chiba Foundation for Health Promotion& Disease Prevention Chiba Japan
| | - Katsuhiro Teramoto
- Department of Obstetrics and Gynecology Yamanashi Prefectural Central Hospital Yamanashi Japan
| | - Tetsuji Kurokawa
- Department of Gynecology and Obstetrics Faculty of Medical Sciences University of Fukui Yoshida‐Gun, Japan
| | - Yoshifumi Takahashi
- Department of Obstetrics and Gynecology Jichi Medical University Tochigi Japan
| | - Osamu Iwanari
- Department of Obstetrics and Gynecology Shimane Prefectural Central Hospital Izumo Shimane Japan
| | - Mitsuaki Suzuki
- Cancer Center Shin‐Yurigaoka General Hospital Kanagawa Japan
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6
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Kilicci C, Çogendez E, Kumru P, Bostanci Ergen E, Koc N, Abide Yayla C. Cytological assessment of endometrial washings obtained with Karman cannula using a liquid-based preparation method for the detection of endometrial pathologies. Arch Gynecol Obstet 2018; 298:171-177. [PMID: 29777346 DOI: 10.1007/s00404-018-4788-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/10/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the diagnostic efficacy and utility of liquid-based cytology in ThinPrep (Cytyc Corporation, Boxborough, MA) for endometrial lesions in patients presenting with abnormal uterine bleeding. MATERIALS AND METHODS Two hundred and thirteen women scheduled for dilatation and curettage because of abnormal uterine bleeding were enrolled in the study. After providing informed consent, all the women proceeded sequentially to endometrial cytology and then dilatation and curettage. RESULTS In the premenopausal group, cytological failure was 4.8%, histopathological failure was 2.4%; cytologic insufficiency in the postmenopausal group was 2.1%, and histopathologic insufficiency was 19.6%. When cytologic and histopathological sufficiency rates were compared in all cases, cytologic insufficiency was 4.2% and histopathologic insufficiency was 6.1%. This difference was statistically significant (p < 0.039). The diagnostic accuracy, sensitivity, specificity, PPV, and NPV of the liquid-based endometrial cytology for premenopausal patients were 96.79, 58.33, 97.92, 70, and 96.58%, respectively. In the postmenopausal cases, the accuracy of diagnosis of endometrial cytology was 97.30%, sensitivity 100%, specificity 96.67%, PPV 87.50%, and NPV 100%. When cytologic and histopathologically inadequate cases were excluded, no cytologic and histopathological abnormal findings were found in endometrial thickness cutoff ≤ 5 mm for all patients. CONCLUSION The use of liquid-based cytology with TVS may contribute to increasing the diagnostic accuracy of the test and reduce unnecessary D&C for women. When TVS is used as a triage indicator, regardless of menopausal status in ≤ 5 mm endometrial thickness cases, endometrial cytology is an absolutely reliable method for detecting cancer.
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Affiliation(s)
- Cetin Kilicci
- Department of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Üsküdar, 34668, Istanbul, Turkey
| | - Ebru Çogendez
- Department of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Üsküdar, 34668, Istanbul, Turkey
| | - Pınar Kumru
- Department of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Üsküdar, 34668, Istanbul, Turkey
| | - Evrim Bostanci Ergen
- Department of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Üsküdar, 34668, Istanbul, Turkey.
| | - Nermin Koc
- Department of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Üsküdar, 34668, Istanbul, Turkey
| | - Cigdem Abide Yayla
- Department of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Üsküdar, 34668, Istanbul, Turkey
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7
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Yang X, Ma K, Chen R, Zhao J, Wu C, Zhang N, Ma X, Dong Y, Zhu S, Liao Q. Liquid-based endometrial cytology associated with curettage in the investigation of endometrial carcinoma in a population of 1987 women. Arch Gynecol Obstet 2017; 296:99-105. [PMID: 28555323 DOI: 10.1007/s00404-017-4400-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 05/12/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to investigate the diagnostic accuracy of liquid-based endometrial cytology, in comparison with histology. METHODS 1987 patients scheduled for hysteroscopy were enrolled in this study. All patients proceeded sequentially through endometrial cytology, hysteroscopy and then dilatation and curettage (D&C). Cytology sampling was performed by brushing the uterus cavity using SAP-1 and the sample was prepared to liquid-based smear using SurePath technology. The slides were stained by Papanicolaou method. All cytological diagnosis was correlated with the D&C histological diagnosis. RESULTS Cyto-histological correlations were possible in 1672 (89.3%) patients: in 254 (12.8%) patients the D&C was inadequate, in 75 (3.8%) patients the cytology was inadequate, and in 14 (0.7%) patients both were inadequate. In postmenopausal women, 758 of 790 cytologies (96.0%) were adequate, while 586 of 790 histologies (74.2%) were adequate. SAP-1 provided more sufficient materials for cytology than D&C for histology (P < 0.001). Taking atypical hyperplasia or worse as a positive result, the diagnostic accuracy of liquid-based endometrial cytology was 86.1%, sensitivity was estimated at 70.3%, specificity at 88.5%, positive predictive value at 48.0% and negative predictive value at 95.2%. Taking endometrial carcinoma as a positive result, the diagnostic accuracy of liquid-based endometrial cytology was 94.4%; sensitivity was estimated at 53.2%, specificity at 98.6%, positive predictive value at 79.8% and negative predictive value at 95.3%. CONCLUSIONS Liquid-based endometrial cytology can be considered a useful method for detecting of endometrial pathology as a first-line approach.
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Affiliation(s)
- Xi Yang
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Medical Center of Tsinghua University, No. 168 Litang Road, Changping District, Beijing, China.,Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Ke Ma
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Medical Center of Tsinghua University, No. 168 Litang Road, Changping District, Beijing, China
| | - Rui Chen
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Medical Center of Tsinghua University, No. 168 Litang Road, Changping District, Beijing, China
| | - Jian Zhao
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Cheng Wu
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Medical Center of Tsinghua University, No. 168 Litang Road, Changping District, Beijing, China
| | - Naiyi Zhang
- Department of Gynecology, Beijing Cancer Hospital, Beijing, China
| | - Xiuhua Ma
- Department of Gynecology, Beijing Daxing District Hospital, Beijing, China
| | - Ying Dong
- Department of Pathology, Peking University First Hospital, Beijing, China
| | - Sainan Zhu
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Qinping Liao
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Medical Center of Tsinghua University, No. 168 Litang Road, Changping District, Beijing, China.
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8
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Zhang H, Wen J, Xu PL, Chen R, Yang X, Zhou LE, Jiang P, Wan AX, Liao QP. Role of Liquid-based Cytology and Cell Block in the Diagnosis of Endometrial Lesions. Chin Med J (Engl) 2017; 129:1459-63. [PMID: 27270542 PMCID: PMC4910370 DOI: 10.4103/0366-6999.183431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Liquid-based cytology (LBC) offers an alternative method to biopsy in screening endometrial cancer. Cell block (CB), prepared by collecting residual cytological specimen, represents a novel method to supplement the diagnosis of endometrial cytology. This study aimed to compare the specimen adequacy and diagnostic accuracy of LBC and CB in the diagnosis of endometrial lesions. Methods: A total of 198 women with high risks of endometrial carcinoma (EC) from May 2014 to April 2015 were enrolled in this study. The cytological specimens were collected by the endometrial sampler (SAP-1) followed by histopathologic evaluation of dilatation and curettage or biopsy guided by hysteroscopy. The residual cytological specimens were processed into paraffin-embedded CB after LBC preparation. Diagnostic accuracies of LBC and CB for detecting endometrial lesions were correlated with histological diagnoses. Chi-square test was used to compare the specimen adequacies of LBC and CB. Results: The specimen inadequate rate of CB was significantly higher than that of LBC (22.2% versus 7.1%, P < 0.01). There were 144 cases with adequate specimens for LBC and CB preparation. Among them, 29 cases were atypical endometrial hyperplasia (11 cases) or carcinoma (18 cases) confirmed by histology evaluation. Taking atypical hyperplasia and carcinoma as positive, the diagnostic accuracy of CB was 95.1% while it was 93.8% in LBC. When combined LBC with CB, the diagnostic accuracy was improved to 95.8%, with a sensitivity of 89.7% and specificity of 97.4%. Conclusions: CB is a feasible and reproducible adjuvant method for screening endometrial lesions. A combination of CB and LBC can improve the diagnostic accuracy of endometrial lesions.
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Affiliation(s)
- Hui Zhang
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jia Wen
- Department of Obstetrics and Gynecology, Tsinghua Chang Gung Hospital, Beijing 102218, China
| | - Pi-Li Xu
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Rui Chen
- Department of Obstetrics and Gynecology, Tsinghua Chang Gung Hospital, Beijing 102218, China
| | - Xi Yang
- Department of Obstetrics and Gynecology, Tsinghua Chang Gung Hospital, Beijing 102218, China
| | - Lian-Er Zhou
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Ping Jiang
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - An-Xia Wan
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Qin-Ping Liao
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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9
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Makris GM, Pouliakis A, Siristatidis C, Margari N, Terzakis E, Koureas N, Pergialiotis V, Papantoniou N, Karakitsos P. Image analysis and multi-layer perceptron artificial neural networks for the discrimination between benign and malignant endometrial lesions. Diagn Cytopathol 2017; 45:202-211. [DOI: 10.1002/dc.23649] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 11/15/2016] [Indexed: 12/26/2022]
Affiliation(s)
- Georgios-Marios Makris
- Unit of Gynecological Oncology, Third Department of Obstetrics and Gynecology; General Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens; Athens Greece
| | - Abraham Pouliakis
- Department of Cytopathology; General Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens; Athens Greece
| | - Charalampos Siristatidis
- Assisted Reproduction Unit, Third Department of Obstetrics and Gynecology; General Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens; Athens Greece
| | - Niki Margari
- Department of Cytopathology; General Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens; Athens Greece
| | | | | | - Vasilios Pergialiotis
- Unit of Gynecological Oncology, Third Department of Obstetrics and Gynecology; General Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens; Athens Greece
| | - Nikolaos Papantoniou
- Unit of Gynecological Oncology, Third Department of Obstetrics and Gynecology; General Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens; Athens Greece
| | - Petros Karakitsos
- Department of Cytopathology; General Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens; Athens Greece
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10
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Ma K, Yang X, Chen R, Zhao J, Dong Y, Zhang NY, Ma XH, Liao QP. Liquid-based endometrial cytology associated with curettage in the investigation of endometrial carcinoma in postmenopausal women. Taiwan J Obstet Gynecol 2016; 55:777-781. [DOI: 10.1016/j.tjog.2015.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2015] [Indexed: 11/26/2022] Open
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11
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Letter to Editor in response to “Detection of endometrial cancer via molecular analysis of DNA collected with vaginal tampons” by Bakkum-Gamez et al. (Gynecol Oncol. 2015). Gynecol Oncol Rep 2015; 14:42-3. [PMID: 26793773 PMCID: PMC4688823 DOI: 10.1016/j.gore.2015.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/20/2015] [Indexed: 11/25/2022] Open
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12
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Wen J, Chen R, Zhao J, Dong Y, Yang X, Liao QP. Combining endometrium sampling device and SurePath preparation to screen for endometrial carcinoma: a validation study. Chin Med J (Engl) 2015; 128:648-53. [PMID: 25698198 PMCID: PMC4834777 DOI: 10.4103/0366-6999.151664] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: The aim of this study was to compare specimen adequacy of SAP-1 provided for cytology with that of dilation and curettage (D & C) or hysteroscopy for histology, and evaluate the accuracy of combining endometrium sampling by SAP-1 and liquid-based cytology using SurePath preparation for screening endometrial carcinoma and its precursor. Methods: Endometrial specimens from women (n = 1514) with risk factors were obtained using an SAP-1 device for cytological analysis; histological samples were obtained from 375 of these women who underwent D & C or hysteroscopy. Cytological specimens were prepared to liquid-based smear using SurePath technology and stained by Papanicolaou. Histological samples were processed in routine pathology and stained by hematoxylin and eosin. Results: Adequate specimens for cytology were obtained from 1458/1541 patients (96.3%), while adequate samples for pathology were obtained from 285/375 patients (76%). However, for postmenopausal women, 1006 of 1045 cytology (86.3%) were adequate, 153 of 238 histology (64.3%) were adequate, it was easier to collect cytological specimens than histological specimens (P < 0.05). The accuracy of endometrial cytology for detecting endometrial carcinoma and its precursor was 92.4% (sensitivity, 73%; specificity, 95.8%; positive predictive value, 75%; and negative predictive value, 95.3%). Conclusions: Endometrial cytology using SAP-1 sampling and SurePath preparation may be a reliable approach for screening patients with endometrial carcinoma and its precursor.
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Affiliation(s)
| | | | | | | | | | - Qin-Ping Liao
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
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13
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Fujiwara H, Takahashi Y, Takano M, Miyamoto M, Nakamura K, Kaneta Y, Hanaoka T, Ohwada M, Sakamoto T, Hirakawa T, Fujiwara K, Suzuki M. Evaluation of Endometrial Cytology: Cytohistological Correlations in 1,441 Cancer Patients. Oncology 2014; 88:86-94. [DOI: 10.1159/000368162] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 09/05/2014] [Indexed: 11/19/2022]
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14
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Fambrini M, Sorbi F, Sisti G, Cioni R, Turrini I, Taddei G, Guaschino S. Endometrial carcinoma in high-risk populations: is it time to consider a screening policy? Cytopathology 2014; 25:71-7. [DOI: 10.1111/cyt.12131] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2013] [Indexed: 01/01/2023]
Affiliation(s)
- M. Fambrini
- Department of Biomedical, Clinical and Experimental Sciences; University of Florence; Florence Italy
| | - F. Sorbi
- Department of Biomedical, Clinical and Experimental Sciences; University of Florence; Florence Italy
| | - G. Sisti
- Department of Biomedical, Clinical and Experimental Sciences; University of Florence; Florence Italy
| | - R. Cioni
- Department of Biomedical, Clinical and Experimental Sciences; University of Florence; Florence Italy
| | - I. Turrini
- Department of Biomedical, Clinical and Experimental Sciences; University of Florence; Florence Italy
| | - G. Taddei
- Department of Biomedical, Clinical and Experimental Sciences; University of Florence; Florence Italy
| | - S. Guaschino
- Department of Biomedical, Clinical and Experimental Sciences; University of Florence; Florence Italy
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15
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Kosmas K, Stamoulas M, Marouga A, Kavantzas N, Patsouris E, Athanassiadou P. Expression of p53 in imprint smears of endometrial carcinoma. Diagn Cytopathol 2013; 42:416-22. [PMID: 24167025 DOI: 10.1002/dc.23056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 06/19/2013] [Accepted: 08/30/2013] [Indexed: 11/11/2022]
Abstract
The aims of this study were to determine the expression of p53 protein in endometrial adenocarcinomas (as a potential prognostic indicator before treatment) as well as normal endometrium in imprint smears and to correlate the results with clinicopathologic parameters of primary untreated endometrial cancer patients. Two hundred fifty five patients were evaluated with endometrial imprint cytology during a 29-month period. Endometrial samples freshly resected from women who underwent total abdominal hysterectomy were studied. One hundred twenty six patients had endometrial carcinoma and 129 cases were diagnosed as normal endometrium. The expression of p53 was assessed by immunocytochemistry. Positive staining was correlated with increased surgical-pathological stage, histological grade and lymph node metastases. High expression of p53 staining was significantly more frequent in histological type II than type I endometrial adenocarcinoma. High-grade endometrial carcinoma had higher proportions and stronger intensity compared with low-grade carcinoma. Negative immunostain for p53 protein was found in proliferative, secretory, and atrophic endometrium. Immunocytochemical findings from p53 stain, in addition to cytomorphologic features, appeared to be useful in the diagnosis and in the postoperative prognosis of endometrial carcinoma in endometrial cytology, especially if combined with other markers. High p53 expression correlates with morphologic features of aggressiveness and the expression pattern of p53 correspond to the expected cyclic/atrophic pattern in normal endometrium.
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Affiliation(s)
- Konstantinos Kosmas
- Department of Cytopathology, Anti-cancer Oncological Hospital St. Savvas, Athens, Greece
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16
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Norimatsu Y, Sakamoto S, Ohsaki H, Ozaki S, Yokoyama T, Shimizu K, Yanoh K, Akiyama M, Bamba M, Kobayashi TK. Cytologic features of the endometrial adenocarcinoma: Comparison of ThinPrep and BD surepath preparations. Diagn Cytopathol 2013; 41:673-81. [DOI: 10.1002/dc.22921] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 08/03/2012] [Indexed: 11/09/2022]
Affiliation(s)
- Yoshiaki Norimatsu
- Department of Medical Technology; Ehime Prefectural University of Health Sciences; Ehime; Japan
| | - Shingo Sakamoto
- Department of Pathology; Matsuyama Red Cross Hospital; Ehime; Japan
| | - Hiroyuki Ohsaki
- Department of Medical Technology; Ehime Prefectural University of Health Sciences; Ehime; Japan
| | - Satoru Ozaki
- Department of Pathology; Kanazawa University Hospital; Ishikawa; Japan
| | - Toshiro Yokoyama
- Department of Pathology; Kurume University Medical Center; Fukuoka; Japan
| | - Keiko Shimizu
- Department of Pathology; Saiseikai Noe Hospital; Imperial Gift Foundation Inc.; Osaka; Japan
| | - Kenji Yanoh
- Department of Gynaecology; Suzuka General Hospital; Mie; Japan
| | - Minoru Akiyama
- Department of Obstetrics and Gynecology; Saiseikai Shiga Hospital; Imperial Gift Foundation Inc.; Shiga; Japan
| | - Masamichi Bamba
- Department of Pathology; Saiseikai Shiga Hospital; Imperial Gift Foundation Inc.; Shiga; Japan
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17
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Norimatsu Y, Yanoh K, Kobayashi TK. The role of liquid-based preparation in the evaluation of endometrial cytology. Acta Cytol 2013; 57:423-35. [PMID: 24021666 DOI: 10.1159/000353148] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 05/09/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Liquid-based preparation (LBP) of the endometrial lesions is an important diagnostic tool for a variety of endometrial abnormalities because of its simplicity and high quali-quantitative diagnostic yield. We aimed to investigate the LBP method for endometrial cytology to evaluate both benign and abnormal endometrial lesions. STUDY DESIGN LBP is a semiautomated methodology that has recently become widely available and has gained popularity as a method of collecting and processing both gynecologic and nongynecologic cellular specimens. RESULTS Some peculiar endometrial cytoarchitectural features were described using LBPs. These were advantageous to screen as compared to conventional slides due to a smaller screening area and an excellent quality of cell preparations. CONCLUSIONS LBP is a useful tool in the cellular diagnosis and follow-up of endometrial abnormalities, which remains complementary to the emerging molecular diagnostic cytopathology. The study of LBPs from endometrial cytology could be challenging since it is affected by numerous look-alikes and diagnostic pitfalls. This review discusses these various entities and takes into consideration the ancillary techniques that may be useful in the diagnostic procedure.
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Affiliation(s)
- Yoshiaki Norimatsu
- Department of Medical Technology, Ehime Prefectural University of Health Sciences, Tobe, Japan
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18
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Fambrini M, Buccoliero AM, Pieralli A, Taddei G. A pilot study evaluating liquid-based endometrial cytology and transvaginal ultrasonography in women with postmenopausal bleeding. Cytopathology 2012; 24:402-3. [DOI: 10.1111/cyt.12027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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19
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Remondi C, Sesti F, Bonanno E, Pietropolli A, Piccione E. Diagnostic accuracy of liquid-based endometrial cytology in the evaluation of endometrial pathology in postmenopausal women. Cytopathology 2012; 24:365-71. [PMID: 22994380 DOI: 10.1111/cyt.12013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- C Remondi
- 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
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Hattori M, Kobayashi TK, Nishimura Y, Machida D, Toyonaga M, Tsunoda S, Ohbu M. Comparative image analysis of conventional and thin-layer preparations in endometrial cytology. Diagn Cytopathol 2012; 41:527-32. [PMID: 22807421 DOI: 10.1002/dc.22891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 04/30/2012] [Accepted: 06/06/2012] [Indexed: 11/09/2022]
Abstract
We evaluated the differences in cytologic findings between conventional and thin-layer preparations in endometrial cytology to introduce the thin-layer method into routine cytology. Eighty patients who had undergone endometrial cytology and biopsy on the same day were selected and we compared the cytological findings between conventional- and thin-layer preparations (TLP) in endometrial cytology. The numbers of neutrophils and cell clusters in the thin-layer method were lower than those in the conventional smear (CSS) method. The average number of neutrophils in endometrioid adenocarcinoma was significantly higher than that in normal morphology endometrium and endometrial hyperplasia. Regarding the shape of the cell clusters, ball-like patterns and round-edged cell clusters were not identified in CSS. The average number of clusters in CSS was significantly greater than that using the TLP. The average of the nuclear area in CSS was significantly larger than that using the TLP, indicating that the nuclear areas in CSS were more uneven than that using the TLP. In the future, it is expected that liquid-based cytology will be applied to the cytological diagnosis of a variety of lesions. The influence on cells due to fixation is considerable in liquid-based preparations. Therefore, if we strive to pick up the differences between CSS and TLP of endometrial samples, the diagnostic accuracy of the latter could be improved.
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Affiliation(s)
- Manabu Hattori
- Department of Clinical Cytology, Kitasato University School of Allied Health Sciences, Kanagawa, Japan
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21
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Scarselli G, Bargelli G, Taddei GL, Marchionni M, Peruzzi E, Pieralli A, Mattei A, Buccoliero AM, Fambrini M. Levonorgestrel-releasing intrauterine system (LNG-IUS) as an effective treatment option for endometrial hyperplasia: a 15-year follow-up study. Fertil Steril 2011; 95:420-2. [DOI: 10.1016/j.fertnstert.2010.07.1044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 06/18/2010] [Accepted: 07/07/2010] [Indexed: 10/19/2022]
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Cytology of the body of the uterus. Diagn Cytopathol 2010. [DOI: 10.1016/b978-0-7020-3154-0.00026-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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23
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24
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Yanoh K, Norimatsu Y, Hirai Y, Takeshima N, Kamimori A, Nakamura Y, Shimizu K, Kobayashi TK, Murata T, Shiraishi T. New diagnostic reporting format for endometrial cytology based on cytoarchitectural criteria. Cytopathology 2008; 20:388-94. [PMID: 18657157 PMCID: PMC2788060 DOI: 10.1111/j.1365-2303.2008.00581.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to develop a new reporting format for endometrial cytology that would standardize the diagnostic criteria and the terminology used for reporting. METHODS In previous studies, cytoarchitectural criteria were found to be useful for the cytological assessment of endometrial lesions. To apply these criteria, an appropriate cytological specimen is imperative. In this article, the requirements of an adequate endometrial cytological specimen for the new diagnostic criteria are first discussed. Then, the diagnostic criteria, standardized on a combination of conventional and cytoarchitectural criteria, are presented. Third, terminology that could be used, not only for reporting the histopathological diagnosis, but also for providing better guidance for the gynaecologist to determine further clinical action, is introduced. The proposed reporting format was investigated using endometrial cytology of 58 cases that were cytologically underestimated or overestimated compared to the histopathological diagnosis made on the subsequent endometrial biopsy or surgical specimens. RESULTS Of the 58 cases, 12 were reassessed as being unsatisfactory for evaluation. Among the remaining 46 cases, 25 of the 27 cases, which had been underestimated and subsequently diagnosed as having endometrial carcinoma or a precursor stage on histopathological examination,were reassessed as recommended for endometrial biopsy. On the other hand, 19 cases overestimated by cytology were all reassessed as not requiring biopsy. CONCLUSIONS The reporting format for endometrial cytology proposed in this article may improve diagnostic accuracy and reduce the number of patients managed inappropriately.
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Affiliation(s)
- K Yanoh
- Department of Gynaecology, Suzuka General Hospital, Mie 513-8630, Japan.
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Norimatsu Y, Miyamoto M, Kobayashi TK, Moriya T, Shimizu K, Yanoh K, Tsukayama C, Miyake Y, Ohno E. Diagnostic utility of phosphatase and tensin homolog, β-catenin, and p53 for endometrial carcinoma by thin-layer endometrial preparations. Cancer 2008; 114:155-64. [DOI: 10.1002/cncr.23495] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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