title: A reporting system for endometrial cytology: Cytomorphologic criteria-Implied risk of malignancy.
abstract: BACKGROUND
  There have been various attempts to assess endometrial lesions on cytological material obtained via direct endometrial sampling. The majority of efforts focus on the description of cytological criteria that lead to classification systems resembling histological reporting formats. These systems have low reproducibility, especially in cases of atypical hyperplasia and well differentiated carcinomas. Moreover, they are not linked to the implied risk of malignancy.
  
  
  METHODS
  The material was collected from women examined at the outpatient department of four participating hospitals. We analyzed 866 consecutive, histologically confirmed cases. The sample collection was performed using the EndoGyn device, and processed via Liquid Based Cytology, namely ThinPrep technique. The diagnostic categories and criteria were established by two cytopathologists experienced in endometrial cytology; performance of the proposed reporting format was assessed on the basis of histological outcome; moreover, the implied risk of malignancy was calculated.
  
  
  RESULTS
  The proposed six diagnostic categories are as follows: (i) nondiagnostic or unsatisfactory; (ii) without evidence of hyperplasia or malignancy; (iii) atypical cells of endometrium of undetermined significance; (iv) atypical cells of endometrium of low probability for malignancy; (v) atypical cells of endometrium of high probability for malignancy; and (vi) malignant. The risk of malignancy was 1.42% ± 0.98%, 44.44% ± 32.46% (nine cases), 4.30% ± 4.12%, 89.80% ± 8.47%, and 97.81% ± 2.45%, respectively.
  
  
  CONCLUSIONS
  We propose a clinically oriented classification scheme consisting of diagnostic categories with well determined criteria. Each diagnostic category is linked with an implied risk of malignancy; thus, clinicians may decide on patient management and eventually reduce unnecessary interventional diagnostic procedures. Diagn. Cytopathol. 2016;44:888-901. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Cytopathology, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Athens, 12462, Greece. nikimarg@gmail.com.
authors.forename: Niki
authors.initials: N
authors.lastname: Margari
authors.affiliation: Department of Cytopathology, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Athens, 12462, Greece.
authors.forename: Abraham
authors.identifier: http://orcid.org/0000-0002-0074-3619
authors.initials: A
authors.lastname: Pouliakis
authors.affiliation: Department of Cytopathology, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Athens, 12462, Greece.
authors.forename: Dionysios
authors.initials: D
authors.lastname: Anoinos
authors.affiliation: 2nd Department of Gynecology, "Saint Savvas" Anticancer Hospital, Athens, 11522, Greece.
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Terzakis
authors.affiliation: 2nd Department of Gynecology, "Saint Savvas" Anticancer Hospital, Athens, 11522, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Koureas
authors.affiliation: 3rd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Athens, 12462, Greece.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Chrelias
authors.affiliation: 3rd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Athens, 12462, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Marios Makris
authors.affiliation: Department of Obstetrics and Gynecology, Division of Colposcopy, Mhtera Maternity Hospital, Athens, Greece.
authors.forename: Assimakis
authors.initials: A
authors.lastname: Pappas
authors.affiliation: 1st Department of Obstetrics and Gynecology, General Maternity District Hospital "Helena Venizelou,", Athens, 115 21, Greece.
authors.forename: Evripidis
authors.initials: E
authors.lastname: Bilirakis
authors.affiliation: 2nd Department of Gynecology, "Saint Savvas" Anticancer Hospital, Athens, 11522, Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Goudeli
authors.affiliation: 2nd Department of Pathology, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Athens, 12462, Greece.
authors.forename: Vasileia
authors.initials: V
authors.lastname: Damaskou
authors.affiliation: 3rd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Athens, 12462, Greece.
authors.forename: Nicolaos
authors.initials: N
authors.lastname: Papantoniou
authors.affiliation: 2nd Department of Pathology, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Athens, 12462, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Panayiotides
authors.affiliation: Department of Cytopathology, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Athens, 12462, Greece.
authors.forename: Petros
authors.initials: P
authors.lastname: Karakitsos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000145:classification / Q000473:pathology*; D016889:Endometrial Neoplasms / Q000145:classification / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test / Q000379:methods / Q000592:standards*; D012720:Severity of Illness Index
keywords: ThinPrep; classification; classification system; diagnosis; endometrial cytology; risk of malignancy