title: Endometrial brush biopsy. An accurate outpatient method of detecting endometrial malignancy.
abstract: OBJECTIVE
  To describe 633 cases using the Tao Brush for endometrial biopsy (EBB) in an outpatient setting.
  
  
  METHODS
  Histologic follow-up specimens within six months of EBB in an outpatient setting were evaluated over a two-year period. Diagnosis by EBB relied mainly on histologic evaluation of hematoxylin and eosin-stained tissue sections and was complemented by additional cytologic smear examination in our laboratory. Diagnostic categories included the following: nondiagnostic (ND), benign endometrium (BE), hyperplasia without atypia (H), atypia (AT) and atypical hyperplasia (AH)/carcinoma (CA). The correlation between EBB and follow-up histology was analyzed.
  
  
  RESULTS
  A total of 633 EBBs were evaluated. Diagnoses were rendered in 569 cases, with a diagnostic rate of 90%. Histologic follow-up was evailable for 156 patients. Twelve AH/CA diagnosed by EBB were confirmed by histologic follow-up as CA. However, there was one false positive case, in which EBB showed AH/CA and dilatation and curettage (D&C) revealed disordered, weakly proliferative endometrium. Nine of 10 EBBs with AT diagnoses were 3 CA, 1 AH and 5 BE on follow-up. Two of eight H had D&C follow-up that also showed H. Histologic follow-up was available in 114 of 538 benign EBBs and showed benign correlation in 112 cases. There were two false negative cases; the EBB diagnoses were atrophic endometrium and weakly proliferative endometrium, while D&C showed focal AH in both cases. Among the ND cases, 18 of 64 had tissue follow-up and disclosed 4 CA, 1 H, 12 BE and 1 ND.
  
  
  CONCLUSIONS
  EBB is a reliable diagnostic tool for endometrial sampling in an outpatient setting. The sensitivity and specificity in identifying CA among satisfactory specimens is 100% and 96%, respectively, when AT or a more severe diagnosis is made by EBB. Assessment of specimen adequacy is important for pathologists interpreting EBB. In our study, four cases of adenocarcinoma were identified in the follow-up D&C in patients with nondiagnostic EBB.
authors.affiliation: Department of Pathology, Ball Memorial Hospital, and Pathologists Associated Medical Laboratory, Muncie, Indiana, USA. wuh@palab.com
authors.forename: Howard Her-Juing
authors.initials: HH
authors.lastname: Wu
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Casto
authors.forename: Tarik M
authors.initials: TM
authors.lastname: Elsheikh
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D001706:Biopsy / Q000379:methods*; D015331:Cohort Studies; D003937:Diagnosis, Differential; D004714:Endometrial Hyperplasia / Q000473:pathology*; D016889:Endometrial Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D015994:Incidence; D008875:Middle Aged; D017698:Postmenopause; D017697:Premenopause; D018570:Risk Assessment; D012680:Sensitivity and Specificity