Cytological scoring and prognosis of poorly differentiated endometrioid adenocarcinoma

Prognostic significance of positive peritoneal cytology in endometrial cancer patients

Although peritoneal cytology has been shown to be an independant predictor of survival in endometrial cancer, the present international federation of gynaecology and obstetrics (FIGO) staging system does not involve it for risk stratification. This work aimed to assess the prognostic importance of PPC (positive peritoneal cytology) in endometrial cancer patients. The medical profiles of uterine carcinoma patients were reviewed who were referred to Khatam-al- Anbia and Bahman hospital within 2010-2019. The factors possibly affecting peritoneal fluid cytology in all patients were analysed. There was a considerable association between survival and the number of lymph nodes involvement (95% CI = 2.5 - 12.51, OR = 5.59, p < .001), stage 3 (95% CI = 2.95-22.10, OR = 7.12, p < .001), stage IV (95% CI = 2.14 - 30.09, OR = 8.04, p < .001), Grade (95% CI = 4.4-47.7, OR = 14.54, p < .001). Positive peritoneal cytology was revealed in our study, as an independent prognostic factor in patients with endometrial cancer. Impact statementWhat is already known on this subject? Peritoneal cytology is one of the independent risk factors for poor survival for endometrial cancer, but international federation of gynaecology and obstetrics (FIGO) staging system does not involve it for risk stratification.What do the results of this study add? Positive peritoneal cytology was revealed in our study, as an independent prognostic factor in patients with endometrial cancer.What are the implications of these findings for clinical practice and/or further research? It is recommended peritoneal cytology for future FIGO staging reviews. Till now, peritoneal washings need to be still regarded as a key part for precise risk-stratification.

Nuclear morphometry as an adjunct to cytopathologic examination of endometrial brushings on LBC samples: A prospective approach to combined evaluation in endometrial neoplasms and look alikes

OBJECTIVE

In this study, we aimed to retrospectively investigate and confirm whether atypical nuclear findings in endometrial cytology are useful when assessed by image morphometry in liquid-based cytology (LBC) and compared with microscopic evaluation.

METHODS

In total, 53 cases were selected for this study, including 11 presenting proliferative endometrium, 12 with surface papillary syncytial change with endometrial glandular and stromal breakdown (EGBD-SPSC), 10 endometrioid carcinoma grade 1 (G1-EEC), 10 EEC grade 3 (G3-EEC), and 10 endometrial serous carcinomas (ESC). Nuclear image morphometry for nuclear geometric features (area, grey value, aspect ratio, internuclear distance, nucleolar diameter) was performed using ImageJ computer software. For assessing nucleoli, 3861 nuclei were measured, and for nuclear findings, except for nucleoli, 4036 nuclei were measured in total.

RESULTS

(a) Compared with G1-EEC, G3-EEC and ESC presented a marked increase in all six parameters (nuclear enlargement, anisonucleosis, nuclear shade, nuclear shape, irregularity of nuclear arrangement, and nucleolar size). (b) EGBD-SPSC presented a marked increase in two parameters (nuclear shade, nuclear shape) when compared with G1/G3-EEC and ESC. (c) Compared with EGBD-SPSC, EEC and ESC demonstrated a marked increase in nucleolar size (≥2.0 μm). (d) ESC presented a marked increase in nucleolar size (≥3.0 μm) when compared with G3-EEC.

CONCLUSIONS

Here we confirmed that atypical nuclear findings evaluated by image morphometry are as useful as microscopic evaluations in endometrial cytology. We believe that the objective evaluation of nucleolar size could contribute to an accurate diagnosis of endometrial-LBC samples.

Comparison of cytological and immunocytochemical methods for detecting apoptotic epithelial cells in cervicovaginal smears

BACKGROUND

Several methods have been applied to detect death cells in tissue, cell culture, and fluid samples. We aimed to compare the cytological and immunocytochemical methods for detecting apoptotic cells in cervicovaginal smears.

METHODS

Cervicovaginal smears were taken from 102 women for various gynecological complaints. The slides were stained using the Papanicolaou (Pap)-staining method for cytological evaluation. Cleaved caspase 3 (CC3) antibody was used to detect apoptosis by immunocytochemically, and H-Score was used for the evaluation. In Pap-stained smears, apoptosis was detected and evaluated using our new scoring system by the examination of morphological changes of epithelial cells such as apoptotic bodies, blebbing, karyopyknosis, karyorrhexis, and karyolysis. We used Kappa analysis to understand whether there is an agreement between cytological and immunocytochemical methods for detecting apoptotic cells.

RESULTS

Cytological and immunocytochemical methods showed similarities at a moderate level (κ = 0.482, P < .001). The cytological and immunocytochemical scores were also similar to each other at a fair level (κ = 0.373, P < .001). Pap smears had a sensitivity of 64.40% (95% CI: 50.12-76.01), specificity of 86.04% (95% CI: 72.65-94.83), positive likelihood ratio of 4.62, negative likelihood ratio of 0.41, positive predictive value of 86.36%, negative predictive value of 63.79%, and overall probability of 73.53% compared to immunocytochemical staining.

CONCLUSIONS

Our results demonstrate that Pap smear and cytological scores alone were not good enough to identify apoptosis compared to the immunocytochemical studies. However, because of its high specificity, it may still be an adequate method to detect apoptotic cells.