title: Diagnostic accuracy of liquid-based endometrial cytology in the evaluation of endometrial pathology in postmenopausal women.
abstract: OBJECTIVE
  The aim of this study was to compare liquid-based endometrial cytology with hysteroscopy and endometrial biopsy regarding its diagnostic accuracy in a series of postmenopausal women with abnormal uterine bleeding (AUB) or asymptomatic women with thickened endometrium assessed by transvaginal ultrasound as a screening procedure.
  
  
  METHODS
  Inclusion criteria were: menopausal status; the presence of AUB and/or thickened endometrium assessed by ultrasound (cut-off 4 mm); a normal Papanicolaou (Pap) smear; and no adnexal pathology at ultrasound. Exclusion criteria were: previous endometrial pathology; and previous operative hysteroscopy. Of 768 postmenopausal women referred to our general gynaecology clinics, 121 fulfilled the inclusion criteria and were recruited to the trial. Twenty-one refused to participate. Cytological sampling was carried out by brushing the uterine cavity using the Endoflower device with no cervical dilation and the vial was processed using a ThinPrep® 2000 automated slide processor. The slides were stained using a Pap method.
  
  
  RESULTS
  In 98 cases with histological biopsies, endometrial cytology detected five cases of endometrial carcinoma, 10 of atypical hyperplasia and 47 of non-atypical hyperplasia; 36 cases were negative. In two cases cytology was inadequate because of uterine cervical stenosis. Taking atypical hyperplasia or worse as a positive test and outcome, the diagnostic accuracy of the endometrial cytology was 93.5%, with a sensitivity of 92% and specificity of 95%, a positive predictive value of 73% and a negative predictive value of 99%. All the carcinomas were detected by cytology. Only 42% of women with a positive diagnosis were symptomatic. The cytological sampling was well tolerated by all patients. No complication was registered.
  
  
  CONCLUSIONS
  Liquid-based endometrial cytology can be considered an useful diagnostic method in the detection of endometrial pathology as a first-line approach, particularly if associated with transvaginal ultrasound.
authors.affiliation: Section of Gynecology, Academic Department of Biomedicine & Prevention and Clinical Department of Surgery, Tor Vergata University Hospital, Rome, ItalyAnatomic Pathology Institute, Department of Biomedicine & Prevention, School of Medicine, Tor Vergata University Hospital, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Remondi
authors.forename: F
authors.initials: F
authors.lastname: Sesti
authors.forename: E
authors.initials: E
authors.lastname: Bonanno
authors.forename: A
authors.initials: A
authors.lastname: Pietropolli
authors.forename: E
authors.initials: E
authors.lastname: Piccione
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003581:Cytodiagnosis / Q000379:methods*; D003937:Diagnosis, Differential; D004714:Endometrial Hyperplasia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008875:Middle Aged; D017698:Postmenopause; D012307:Risk Factors; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology*