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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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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3
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Margari N, Pouliakis A, Aninos D, Meristoudis C, Stamataki M, Panayiotides I, Karakitsos P. Internal quality control in an academic cytopathology laboratory for the introduction of a new reporting system for endometrial cytology. Diagn Cytopathol 2017; 45:883-888. [PMID: 28731534 DOI: 10.1002/dc.23787] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/29/2017] [Accepted: 07/05/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND To evaluate reproducibility of a reporting system for endometrial cytology. METHODS Cytologic slides from 49 patients, prepared via liquid based cytology, were blindly examined by five cytopathologists of various experience levels, applying a recently introduced reporting system as previously reported. The agreement among cytopathologists was evaluated via Kappa (κ) statistics and the Kendall's Coefficient of Variation (W); cytologic results were compared with the relevant histologic report. RESULTS Substantial agreement among all five raters was found in the benign, ACE-L and malignant categories, fair agreement in inadequate and ACE-H categories, whereas only slight agreement in ACE-U. For the three more experienced cytopathologists, an almost perfect agreement was found in inadequate, benign, and ACE-L categories, substantial agreement in ACE-H and malignant categories and fair agreement in ACE-U category. Overall agreement for all five cytopathologists and for all categories was moderate, whereas it was very high for the three senior raters. Using the Kendall's test, both five cytopathologists (W = 0.81) and the three senior ones (W = 0.93) had very high agreement. Sensitivity: 83.33-92.59%, specificity: 83.33-94.74%, ROC area: 71.72-90.3%. CONCLUSION Application of appropriate statistical tests shows that integration of a new reporting cytologic system is effective with an overall accuracy around 90%. Both statistical tests applied disclosed lower agreement rates among both all five raters and the three most experienced ones in the intermediate categories constituting the gray zone, thus delineating the need for better training of cytopathologists to correctly identify diagnostic criteria for classification of a given case into these categories.
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Affiliation(s)
- Niki Margari
- Department of Cytopathology, National and Kapodistrian University of Athens, "Attikon", University Hospital, 1, Rimini street, Haidari, GR-12462, Athens, Greece
| | - Abraham Pouliakis
- Department of Cytopathology, National and Kapodistrian University of Athens, "Attikon", University Hospital, 1, Rimini street, Haidari, GR-12462, Athens, Greece
| | - Dionysios Aninos
- Department of Cytopathology, National and Kapodistrian University of Athens, "Attikon", University Hospital, 1, Rimini street, Haidari, GR-12462, Athens, Greece
| | - Christos Meristoudis
- Department of Cytopathology, National and Kapodistrian University of Athens, "Attikon", University Hospital, 1, Rimini street, Haidari, GR-12462, Athens, Greece.,Institute of Pathology, Aalborg University Hospital, Ladegardsgade 3, Aalborg, 9100, Denmark
| | - Magdalini Stamataki
- Department of Cytopathology, National and Kapodistrian University of Athens, "Attikon", University Hospital, 1, Rimini street, Haidari, GR-12462, Athens, Greece
| | - Ioannis Panayiotides
- 2nd Department of Pathology, National and Kapodistrian University of Athens, "Attikon", University Hospital, 1, Rimini street, Haidari, GR-12462, Athens, Greece
| | - Petros Karakitsos
- Department of Cytopathology, National and Kapodistrian University of Athens, "Attikon", University Hospital, 1, Rimini street, Haidari, GR-12462, Athens, Greece
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4
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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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5
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Margari N, Pouliakis A, Anoinos D, Terzakis E, Koureas N, Chrelias C, Marios Makris G, Pappas A, Bilirakis E, Goudeli C, Damaskou V, Papantoniou N, Panayiotides I, Karakitsos P. A reporting system for endometrial cytology: Cytomorphologic criteria-Implied risk of malignancy. Diagn Cytopathol 2016; 44:888-901. [DOI: 10.1002/dc.23605] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/11/2016] [Accepted: 08/22/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Niki Margari
- Department of Cytopathology; National and Kapodistrian University of Athens, “ATTIKON” University Hospital; Athens 12462 Greece
| | - Abraham Pouliakis
- Department of Cytopathology; National and Kapodistrian University of Athens, “ATTIKON” University Hospital; Athens 12462 Greece
| | - Dionysios Anoinos
- Department of Cytopathology; National and Kapodistrian University of Athens, “ATTIKON” University Hospital; Athens 12462 Greece
| | - Emmanouil Terzakis
- 2nd Department of Gynecology; “Saint Savvas” Anticancer Hospital; Athens 11522 Greece
| | - Nikolaos Koureas
- 2nd Department of Gynecology; “Saint Savvas” Anticancer Hospital; Athens 11522 Greece
| | - Charalampos Chrelias
- 3rd Department of Obstetrics and Gynecology; National and Kapodistrian University of Athens, “ATTIKON” University Hospital; Athens 12462 Greece
| | - George Marios Makris
- 3rd Department of Obstetrics and Gynecology; National and Kapodistrian University of Athens, “ATTIKON” University Hospital; Athens 12462 Greece
| | - Assimakis Pappas
- Department of Obstetrics and Gynecology, Division of Colposcopy; Mhtera Maternity Hospital; Athens Greece
| | - Evripidis Bilirakis
- 1st Department of Obstetrics and Gynecology; General Maternity District Hospital “Helena Venizelou,”; Athens 115 21 Greece
| | - Christina Goudeli
- 2nd Department of Gynecology; “Saint Savvas” Anticancer Hospital; Athens 11522 Greece
| | - Vasileia Damaskou
- 2nd Department of Pathology; National and Kapodistrian University of Athens, “ATTIKON” University Hospital; Athens 12462 Greece
| | - Nicolaos Papantoniou
- 3rd Department of Obstetrics and Gynecology; National and Kapodistrian University of Athens, “ATTIKON” University Hospital; Athens 12462 Greece
| | - Ioannis Panayiotides
- 2nd Department of Pathology; National and Kapodistrian University of Athens, “ATTIKON” University Hospital; Athens 12462 Greece
| | - Petros Karakitsos
- Department of Cytopathology; National and Kapodistrian University of Athens, “ATTIKON” University Hospital; Athens 12462 Greece
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6
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A Pyrosequencing Assay for the Quantitative Methylation Analysis of GALR1 in Endometrial Samples: Preliminary Results. BIOMED RESEARCH INTERNATIONAL 2015; 2015:756359. [PMID: 26504828 PMCID: PMC4609388 DOI: 10.1155/2015/756359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/03/2015] [Accepted: 06/04/2015] [Indexed: 01/28/2023]
Abstract
Endometrial cancer is the most common malignancy of the female genital tract while aberrant DNA methylation seems to play a critical role in endometrial carcinogenesis. Galanin's expression has been involved in many cancers. We developed a new pyrosequencing assay that quantifies DNA methylation of galanin's receptor-1 (GALR1). In this study, the preliminary results indicate that pyrosequencing methylation analysis of GALR1 promoter can be a useful ancillary marker to cytology as the histological status can successfully predict. This marker has the potential to lead towards better management of women with endometrial lesions and eventually reduce unnecessary interventions. In addition it can provide early warning for women with negative cytological result.
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7
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Kato R, Hasegawa K, Torii Y, Hirasawa Y, Udagawa Y, Fukasawa I. Cytological scoring and prognosis of poorly differentiated endometrioid adenocarcinoma. Acta Cytol 2015; 59:83-90. [PMID: 25765171 DOI: 10.1159/000375113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/05/2015] [Indexed: 01/17/2023]
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.
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8
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Kaur N, Chahal JS, Bandlish U, Kaul R, Mardi K, Kaur H. Correlation between cytological and histopathological examination of the endometrium in abnormal uterine bleeding. J Cytol 2014; 31:144-8. [PMID: 25538383 PMCID: PMC4274525 DOI: 10.4103/0970-9371.145645] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Abnormal uterine bleeding (AUB) is a common problem for which women seek gynecological consultation. Endometrial aspiration cytology (EAC) is an acceptable and valuable diagnostic procedure for screening the endometrial status. Materials and Methods: Endometrial aspiration using a menstrual regulation (MR) syringe and a 4 mm Karman's cannula was performed just prior to D and C in 100 women presenting with AUB. Smears were reviewed for cytomorphological findings and were correlated with the histopathological findings. These findings were categorized as benign endometrium, endometrial hyperplasia, malignancy and inadequate smears. Results: Age of the patients ranged from 19 to 70 years. In our study, the accuracy in diagnosing benign conditions of endometrium, hyperplasia, and malignancy on aspiration cytology were 93.88%, 96.94% and 96.84%, respectively. Conclusions: Endometrial aspiration is an effective, useful and a minimally invasive procedure. With an experienced cytologist, it can be used routinely for the primary investigation of women with AUB, provided all the points of discrepancies are taken care of.
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Affiliation(s)
- Navjot Kaur
- Department of Pathology, Dr. RP Govt. Medical College, Tanda, India
| | - Jagjit S Chahal
- Department of Biochemistry, Dr. RP Govt. Medical College, Tanda, India
| | - Usha Bandlish
- Department of Pathology, GMC, Patiala, Punjab, India
| | - Rashmi Kaul
- Department of Pathology, Dr. RP Govt. Medical College, Tanda, India
| | - Kavita Mardi
- Department of Pathology, IGMC, Shimla, Himachal Pradesh, India
| | - Harjit Kaur
- Department of Pathology, Dr. RP Govt. Medical College, Tanda, India
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9
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Di Lorito A, Zappacosta R, Capanna S, Gatta DM, Rosini S, Schmitt FC. Expression of PTEN in endometrial liquid-based cytology. Acta Cytol 2014; 58:495-500. [PMID: 25358681 DOI: 10.1159/000367961] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 08/27/2014] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Endometrial cytology offers a reliable alternative to biopsy in endometrial cancer detection and it may be useful in obtaining material to study prognostic and predictive markers. Over the years, new sampling devices have been developed. Molecular alterations in endometrial cancers were previously described using formalin-fixed paraffin-embedded tissues with particular attention, in endometrioid carcinomas, to the PTEN-PI3K pathway. PTEN evaluation could be useful in endometrial carcinomas for selecting patients for target therapies. STUDY DESIGN We studied 51 endometrial samples collected using the Endogyn device and 71 obtained with the Endoflower dispositive device, and processed using liquid-based cytology. Most of the cases were matched with a corresponding histological biopsy. The overall accuracy of Endoflower was 100%. Immunohistochemistry (IHC) and immunocytochemistry (ICC) for PTEN were performed using monoclonal antibody 6H2.1 from DAKO. RESULTS The IHC showed PTEN-null glands in 4 cases. The same cancers were negative in ICC. Among the 10 carcinomas on cytology, PTEN-null glands were found in 1 case. All the normal endometrium control cases were positive in cytology and histology. CONCLUSIONS Our results suggest that endometrial devices provide useful material for the diagnosis and evaluation of PTEN expression.
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Affiliation(s)
- Alessia Di Lorito
- Experimental and Clinical Science, G. d'Annunzio University, Chieti, Italy
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10
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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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11
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Pouliakis A, Margari C, Margari N, Chrelias C, Zygouris D, Meristoudis C, Panayiotides I, Karakitsos P. Using classification and regression trees, liquid-based cytology and nuclear morphometry for the discrimination of endometrial lesions. Diagn Cytopathol 2013; 42:582-91. [DOI: 10.1002/dc.23077] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 10/29/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Abraham Pouliakis
- Department of Cytopathology; University of Athens; “ATTIKON” University Hospital; Athens Greece
| | | | - Niki Margari
- Department of Cytopathology; University of Athens; “ATTIKON” University Hospital; Athens Greece
| | - Charalampos Chrelias
- 3rd Department of Obstetrics and Gynecology; University of Athens; “ATTIKON” University Hospital; Athens Greece
| | - Dimitrios Zygouris
- 3rd Department of Obstetrics and Gynecology; University of Athens; “ATTIKON” University Hospital; Athens Greece
| | - Christos Meristoudis
- Department of Cytopathology; University of Athens; “ATTIKON” University Hospital; Athens Greece
| | - Ioannis Panayiotides
- 2nd Department of Pathology; University of Athens; “ATTIKON” University Hospital; Athens Greece
| | - Petros Karakitsos
- Department of Cytopathology; University of Athens; “ATTIKON” University Hospital; Athens Greece
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12
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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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13
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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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14
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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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Arafa M, Somja J, Dehan P, Kridelka F, Goffin F, Boniver J, Delvenne P. Current concepts in the pathology and epigenetics of endometrial carcinoma. Pathology 2011; 42:613-7. [PMID: 21080868 DOI: 10.3109/00313025.2010.520307] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In the Western world, endometrial carcinoma is the most common malignant tumour of the female genital tract and is the fourth most common cancer in women. Two different clinicopathological subtypes are recognised: the oestrogen-related (type I, endometrioid) and the non-oestrogen related (type II, non-endometrioid). This article reviews the epidemiology, risk factors, genetic alterations during endometrial carcinogenesis, features of tumours and precursors and early detection of the disease. Insights into the epigenetic alterations, with emphasis on DNA methylation during endometrial carcinogenesis, and their diagnostic value are also provided.
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Affiliation(s)
- Mohammad Arafa
- Department of Pathology, Faculty of Medicine, Mansoura University, Egypt
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16
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Watanabe J, Nishimura Y, Tsunoda S, Kawaguchi M, Okayasu I, Kuramoto H. Liquid-based preparation for endometrial cytology--usefulness for predicting the prognosis of endometrial carcinoma preoperatively. Cancer 2009; 117:254-63. [PMID: 19562745 DOI: 10.1002/cncy.20035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The authors evaluated the applicability and usefulness of immunocytochemical staining for cyclin A, p53, estrogen receptor alpha (ER-alpha), and progesterone receptor B (PR-B) as a preoperative prognostic indicators for endometrial carcinoma using endometrial cytology with the liquid-based cytology (LBC) method. METHODS Cytologic specimens from 44 patients who had endometrial carcinoma were prepared with the LBC method. The results of immunocytochemical and immunohistochemical staining for cyclin A, p53, ER-alpha, and PR-B were compared with clinicopathologic parameters and prognosis. RESULTS Patients who had positive results for cyclin A and p53 and negative results for ER-alpha and PR-B appeared to have unfavorable clinicopathologic characteristics, such as high-grade histology, advanced clinical stage, lymphovascular space involvement (LVSI), and deeper myometrial invasion (MI), and had a poor prognosis. In contrast, patients who had positive results for ER-alpha and PR-B, and negative results for cyclin A and p53 had favorable characteristics, such well differentiated tumor, early clinical stage, negative LVSI, and less MI, and had a good prognosis. Immunostaining results from cytologic specimens obtained in the clinic and at surgery and from histologic specimens obtained at surgery were correlated positively. CONCLUSIONS Consistent specimens that were prepared using the LBC method facilitated multiple immunocytochemical analyses. Endometrial cytology with the LBC method was useful for predicting the prognosis of patients with endometrial carcinoma before therapy.
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Affiliation(s)
- Jun Watanabe
- Department of Clinical Cytology, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Kanagawa, Japan.
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Fambrini M, Buccoliero AM, Bargelli G, Cioni R, Piciocchi L, Pieralli A, Andersson KL, Scarselli G, Taddei G, Marchionni M. Clinical utility of liquid-based cytology for the characterization and management of endometrial polyps in postmenopausal age. Int J Gynecol Cancer 2008; 18:306-11. [PMID: 17624992 DOI: 10.1111/j.1525-1438.2007.01019.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The proper management of endometrial polyps still represents a clinical ongoing challenge, especially when they are asymptomatic and occasionally discovered. The aim of this study was to evaluate liquid-based endometrial cytology to manage endometrial polyps in postmenopausal age by its ability to exclude hidden premalignant and malignant changes within polyps. Three hundred fifty-nine consecutive postmenopausal patients who underwent hysteroscopic diagnosis of endometrial polyp over a 3-year period and who were scheduled for surgical removal within the three subsequent months were retrospectively evaluated. Histologic results after resection during operative hysteroscopy or during hysterectomy were compared with liquid-based cytology and endometrial biopsy obtained at the time of diagnostic hysteroscopy. Eight of 359 patients (2.2%) had malignant or premalignant polyps interpreted as benign finding at hysteroscopy. Unsatisfactory samples were higher for endometrial biopsy compared to liquid-based cytology in the whole series and in the subgroup of low-risk asymptomatic patients (P< 0.001). Endometrial biopsy and liquid-based cytology revealed a sensitivity of 62% and 87.5%, respectively and a 100% specificity. Considering the subgroup of low-risk asymptomatic patients, liquid-based cytology disclosed all the five pathologic lesions with a 100% sensitivity and specificity. In conclusion, liquid-based cytology proved to be a useful tool to establish the nature of endometrial polyps in postmenopausal patients. Complete removal of the lesion should be offered to all symptomatic patients and those with established risk factors for endometrial cancer. Conversely, a wait and see attitude should be considered in case of asymptomatic low-risk polyps with typical appearance on hysteroscopy and negative liquid-based cytology.
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Affiliation(s)
- M Fambrini
- Department of Gynecology, Perinatology, and Human Reproduction, University of Florence, School of Medicine, Florence, Italy.
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Buccoliero AM, Fambrini M, Gheri CF, Castiglione F, Garbini F, Barbetti A, Degl’Innocenti DR, Moncini D, Taddei A, Bargelli G, Scarselli G, Marchionni M, Taddei GL. Surveillance for Endometrial Cancer in Women on Tamoxifen: The Role of Liquid-Based Endometrial Cytology – Cytohistological Correlation in a Population of 168 Women. Gynecol Obstet Invest 2008; 65:240-6. [DOI: 10.1159/000113047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Accepted: 07/11/2007] [Indexed: 11/19/2022]
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Kondo E, Tabata T, Koduka Y, Nishiura K, Tanida K, Okugawa T, Sagawa N. What is the best method of detecting endometrial cancer in outpatients?-endometrial sampling, suction curettage, endometrial cytology. Cytopathology 2007; 19:28-33. [PMID: 17944955 DOI: 10.1111/j.1365-2303.2007.00509.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Office methods of endometrial sampling for outpatients with abnormal uterine bleeding should be minimally invasive. The purpose of this study was to determine the best method for detecting endometrial cancer in an outpatients setting. METHODS In all, 114 symptomatic women who were suspected of having endometrial disease by their local gynaecologist were enrolled in this study. After pelvic examination and transvaginal ultrasonography, endometrial cytology, suction endometrial curettage, and four-site endometrial biopsy were performed, in this order without anaesthesia in each patient. After endometrial sampling, the patient was asked to comment on the intensity of any pain experienced during each procedure. Then the final histological diagnosis made from the surgical materials was compared with the results of the three pre-operative methods. RESULTS Among the 114 consecutive patients, 56 had endometrial carcinoma, three had carcinosarcoma, six had endometrial hyperplasia, and 49 had benign conditions. The sensitivity of detecting malignancy was 88% (52/59) with endometrial cytology, 92% (54/59) with suction curettage, and 88% (52/59) with four-site biopsy. When endometrial cytology was combined with suction curettage, the sensitivity of detecting malignancy was increased from 92% to 98%, whereas the sensitivity was increased from 88% to 97%, when endometrial cytology was added to four-site biopsy. Suction curettage was significantly less painful than four-site biopsy. CONCLUSION Our data indicated that suction curettage plus endometrial cytology was the best combination for pathological examination of outpatients with abnormal uterine bleeding.
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Affiliation(s)
- E Kondo
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu, Mie, Japan.
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