Endometrial brush biopsy. An accurate outpatient method of detecting endometrial malignancy.
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.
Wu
Howard Her-Juing
HH
Department of Pathology, Ball Memorial Hospital, and Pathologists Associated Medical Laboratory, Muncie, Indiana, USA. wuh@palab.com
Casto
Bryan D
BD
Elsheikh
Tarik M
TM
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