Experience with Endopap endometrial sampling in the cytodiagnosis of endometrial carcinoma and its precursor lesions. I. A correlative cytologic-histologic-hysteroscopic diagnostic pilot study.
From June 1 through December 3, 1991, 146 women were referred to the Gynecology Outpatient Clinic of Nahariyya Medical Center for uterine bleeding and pathologic conditions. Their ages ranged from < 40 (26 patients) to > or = 60 (18 patients), with 60 (41%) in the 40-49 age group. An Endopap endometrial sampling pilot study was undertaken to find a correlative index between cytologic, histologic and hysteroscopic sampling methods as well as to investigate the possibility that Endopap sampling could avoid excessive use of nontherapeutic dilation and curettage. In 118 patients for whom concomitant cytologic and histologic specimens were available there was no statistically significant difference between the number of correct cytologic and histologic diagnoses of intrauterine pathology. Cytodiagnostic accuracy of the Endopap samples was expressed in terms of sensitivity (68.2%), specificity (80.7%), predictive value of a malignant test result (100%) and predictive value (PV) of an abnormal (hyperplasia) test result (73.2%). The lower values for sensitivity, specificity and PV in this study as compared with those in the literature were probably due to three attenuating factors: the relatively small number of patients (146), the fact that the cytodiagnostic accuracy for hyperplasia and precursor lesions of endometrial carcinoma is significantly lower than for histologic diagnosis, and the presence of 15 (10.3%) inadequate cytologic specimens. The results did tend to concur with the range of reported results. It is recommended that Endopap sampling be employed in cases of medically and anatomically contraindicated dilation and curettage--e.g., cervical canal stenosis and intrauterine adhesions (Asherman's syndrome)--in monitoring perimenopausal and postmenopausal patients on estrogen replacement therapy and in obese women, diabetics and hypertensives at risk of developing endometrial hyperplasia. The study also showed that the combined hysteroscopic and Endopap techniques could result in increased rates of sensitivity and specificity.
Suprun
H Z
HZ
Department of Pathology and Cytology, Nahariyya Government and Regional Medical Center of the Western Galilee, Israel.
Taendler-Stolero
R
R
Schwartz
J
J
Ettinger
M
M
D000328:Adult; D000367:Age Factors; D016889:Endometrial Neoplasms / Q000473:pathology*; D004717:Endometrium / Q000166:cytology / Q000473:pathology*; D005260:Female; D006801:Humans; D006965:Hyperplasia; D015907:Hysteroscopy; D008875:Middle Aged; D010865:Pilot Projects; D017698:Postmenopause; D011230:Precancerous Conditions / Q000473:pathology*