Degenerative necrotic endometrial debris in Papanicolaou smears. The role in the prediction of endometrial pathology

Current strategies in the diagnosis of endometrial cancer

PURPOSE

Endometrial cancer is the most common gynecological malignancy in developed countries. There are no uniform recommendations for endometrial cancer screening in the general population. Therefore, it is of paramount importance that the primary physician profoundly understands, and is familiar with the methods for prevention and early detection of endometrial cancer. The aim of this review is to provide the primary physician with a toolbox to reach these goals.

METHODS

We performed a systemic review to summarize the current strategies to diagnose and prevent endometrial cancer. Many published articles from the last years were identified and included.

RESULTS

A systematic review that summarizes the important subjects in the diagnosis and prevention of endometrial cancer.

CONCLUSION

Maintaining a high index of suspicion and obtaining endometrial biopsies from all suspected patients is the key for achieving a timely diagnosis.

Recommendations on Quality Control and Quality Assurance in Cervical Cytology

OBJECTIVE

We aimed to critically evaluate the importance of quality control (QC) and quality assurance (QA) strategies in the routine work of uterine cervix cytology.

STUDY DESIGN

We revised all the main principles of QC and QA that are already being implemented worldwide and then discussed the positive aspects and limitations of these as well as proposing alternatives when pertinent.

RESULTS

A literature review was introduced after highlighting the main historical revisions, and then a critical evaluation of the principal innovations in screening programmes was conducted, with recommendations being postulated.

CONCLUSIONS

Based on the analysed data, QC and QA are two essential arms that support the quality of a screening programme.

The Diagnostic Value of Routine Papanicolaou Smears for Detecting Endometrial Cancers: An Update

OBJECTIVE

The presence of degenerative endometrial debris and abnormal endometrial cells is considered to be the hint for endometrial pathology. The purpose of this study was to evaluate the efficacy of Papanicolaou (Pap) smears in detecting endometrial cancers.

STUDY DESIGN

There were 146 cases of endometrial cancer diagnosed at our institute in 2000-2002 and 271 in 2010-2012. Among them, 57 and 95 relevant reports of Pap smears 6 months prior to the histology diagnosis were retrieved for this study, respectively. In the first time period, new criteria for detecting endometrial lesions had not yet been incorporated into routine screening.

RESULTS

Twenty cases (21%) of adenocarcinoma, 12 (13%) of atypical glandular cells, 4 (4%) of endometrial debris and 59 (62%) negative reports were found among the more recent 95 relevant Pap smears. The overall efficacy of the Pap smear for detecting endometrial malignancy was 38%, higher than 10 years previously (30%).

CONCLUSION

Although the Pap smear was originally designed to screen cervical lesions, more effective detection of endometrial lesions could be achieved by adding new criteria to the routine screening.

Prognostic factors of primary fallopian tube cancer in a single institute in Taiwan

OBJECTIVE

To improve the understanding of primary fallopian tube carcinoma (PFTC) through an analysis of possible clinical and pathologic determinants of prognosis.

METHODS

A retrospective review of the database of a tertiary hospital in Taiwan for 1978-2007 was conducted to identify patients with a diagnosis of PFTC and to evaluate the clinicopathologic features associated with PFTC outcome.

RESULTS

Fifty-eight patients (mean age 62.5 years) had a diagnosis of PFTC. Stage III/IV disease (55%) and poorly differentiated tumors (52%) were most common. The median follow-up was 93 months (range, 11-333 months). The 5-year disease-free survival rate was 59%, and the overall survival rate was 64%. Factors important in disease-free and overall survival in univariate analysis included the presence of pelvic and/or para-aortic lymph node metastases, International Federation of Gynecology and Obstetrics stage, high preoperative carbohydrate antigen 125 serum level, completion of optimal debulking surgery, and the use of paclitaxel-based chemotherapy; however, only patients with optimal cytoreduction had a decreased hazard of recurrence (hazard ratio [HR] 0.06; 95% confidence interval [CI] 0.01-0.23) and mortality (HR 0.08; 95% CI, 0.02-0.31) in multivariate analysis.

CONCLUSION

Advanced tumor stage, in particular the presence of lymph node metastases, worsened the prognosis of patients with PFTC. However, optimal debulking surgery significantly improved the prognosis, emphasizing the importance of the treatment strategy.