Cytological criteria of endometrial lesions with emphasis on stromal and epithelial cell clusters: result of 8 years of experience with intrauterine sampling

Evaluation of cellular adequacy in endometrial liquid-based cytology

OBJECTIVE

This study evaluated cellular adequacy in endometrial liquid-based cytology (LBC) specimens.

METHODS

In total, 1267 cases were obtained and the rate of unsatisfactory specimen and diagnostic accuracy for malignancy were assessed. If ≥10 cellular clusters composed of ≤30 endometrial cells were found per specimen, then the sample was provisionally considered adequate.

RESULTS

The unsatisfactory rate (with fewer than 10 clusters) was 15.4%. Diagnostic accuracy in specimens with ≥10 clusters was significantly higher (90.5% vs 36.4%) than that in specimens with fewer than10 clusters. Moreover, the unsatisfactory rate in patients aged ≥60 years was significantly higher (33.8% vs 13.2%) than that in patients younger than 60 years. Although the unsatisfactory rate was decreased, significant differences were not found between cases with fewer than five clusters (22.6%) and fewer than 10 clusters (33.8%) in patients aged ≥60 years. Diagnostic accuracy in cases with five or more clusters was significantly higher (90.3% vs 0%) than that in cases with fewer than five clusters.

CONCLUSIONS

We propose that ≥10 clusters with ≥30 endometrial cells per cluster could be used as a specimen adequacy criterion for endometrial LBC. If ≥10 clusters cannot be found in patients aged ≥60 years, then the use of the alternative criterion of five or more clusters may yield satisfactory specimen adequacy.

Diagnostic Utility of Endometrial Aspiration Cytology in Women with Abnormal Uterine Bleeding

Context

Abnormal uterine bleeding (AUB) is a common problem for which women seek gynecological consultation. Endometrial aspiration cytology (EAC) has emerged as a minimally invasive and cost-effective diagnostic procedure for screening the endometrial status of these patients that can aid in diagnosis in high-burden and resource-limited settings.

Aims

The study was conducted to evaluate the utility of EAC in women with AUB, and the cytological diagnosis was compared with the histopathology.

Materials and Methods

A total of 100 patients presenting with AUB were subjected to EAC using a 4-mm Karman's cannula. Later, they also underwent endometrial dilation and curettage. The cytology smears were evaluated for architectural and cytomorphological features. The cytological diagnoses henceforth made were compared with the histopathological diagnosis to calculate sensitivity, specificity, and diagnostic accuracy of EAC.

Results

EAC showed a sample adequacy of 89% viz a viz 90% for histopathology. EAC showed a sensitivity of 87.5% and 100% for diagnosing benign and malignant conditions, respectively. There was a good overall agreement between cytological and histopathological diagnosis (κ = 0.585).

Conclusions

EAC is an effective and minimally invasive procedure for the primary investigation of women with AUB.

The role of liquid-based preparation in the evaluation of endometrial cytology

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.

A multivariate statistical study to obtain effective criteria to detect well-differentiated adenocarcinoma in endometrial cytology

Consistency in endometrial cytology is relatively poor. This can be partly attributed to generally accepted criteria based on cellular features. The cytological distinction between grade-1 adenocarcinoma and endometrial hyperplasia is more reliant on architectural features than cellular features. We examined statistical criteria based on cytoarchitecture for detecting grade-1 adenocarcinoma in endometrial cytology. Histologically, the study population consisted of 11 cases of grade-1 adenocarcinoma, 6 of atypical endometrial hyperplasia, 16 of endometrial hyperplasia without atypia, and 74 of a normal proliferative endometrium. In each case, all cellclumps were divided into five patterns (tubular; sheet; dilated and/or branched tubular; regular overlapping; atypical). The frequencies of each pattern were submitted to five-variate cluster analysis. The validity and reproducibility of cluster analysis were tested by canonical discriminant analysis and multigroup linear discriminant analysis, respectively. All 107 cases were classified into three groups, A (11), B (36), and C (60), by five-variate cluster analysis. In comparison with this classification and histopathologic diagnosis, group A corresponded to adenocarcinoma, and groups B and C correlated with non-carcinoma. Most cases of atypical endometrial hyperplasia were included in group B. These data suggest that statistical groupings based on cytoarchitecture are useful in the discrimination of grade-1 adenocarcinoma from endometrial hyperplasia and normal tissue.