Objective: To investigate the diagnostic utility of endometrial (EM) cell block (CB) cytology for the detection of intrauterine malignancy in postmenopausal women. Methods: We reviewed the medical records of 104 postmenopausal women between January 2012 and November 2014. We reviewed symptoms upon admission, body mass index, parity, transvaginal ultrasonographic findings, and histopathological results based on CB and conventional cytology. Results: The mean age was 62.6 (range 48-95) years. The mean menopausal age was 50.8 years and the mean duration of menopause was 12.0 years. The sensitivity of CB and conventional cytology was 82.3% (29/35) and 85.7% (30/35) and the specificity was 98.6% (68/69) and 94.2% (65/69), respectively. The sensitivity and specificity of CB cytology combined with conventional cytology were 82.3% (29/35) and 94.2% (65/69), respectively. The predictive values for EM hyperplasia and type-II carcinoma were 100 and 85.7%, respectively. Conclusion: CB cytology provides specimens for examination in a single outpatient session. Additionally, immunohistochemical staining can provide useful information for histological diagnosis. A combination of CB and conventional cytology can improve the diagnostic accuracy of EM lesions and may be a valid method for screening in postmenopausal women.

Keywords:
Endometrial cell block cytology, Endometrial cancer, Postmenopausal women, Immunohistochemistry
1.
Byme AJ: Endocyte endometrial smears in the cytodiagnosis of endometrial carcinoma. Acta Cytol 1990;34:373-381.
2.
Bistoletti P, Hjerpe A, Möllerström G: Cytological diagnosis of endometrial cancer and preinvasive endometrial lesions. A comparison of the Endo-Pap sampler with fractional curettage. Acta Obstet Gynecol Scand 1988;67:343-345.
3.
Yanoh K, Hirai Y, Sakamoto A, et al: New terminology for intrauterine endometrial samples: a group study by the Japanese Society of Clinical Cytology. Acta Cytol 2012;56:233-241.
4.
Dijkhuizen FP, Mol BW, Brolmann HA, Heintz AP: The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis. Cancer 2000;89:1765-1772.
5.
Yanaki F, Hirai Y, Hanada A, Ishitani K, Matsui H: Liquid-based endometrial cytology using SurePath™ is not inferior to suction endometrial tissue biopsy in clinical performance for detecting endometrial cancer including atypical endometrial hyperplasia. Acta Cytol 2017;61:133-139.
6.
Del Priore G, Williams R, Harbatkin CB, Wan LS, Mittal K, Yang GC: Endometrial brush biopsy for the diagnosis of endometrial cancer. J Reprod Med 2001;46:439-443.
7.
Williams AR, Brechin S, Porter AJ, Warner P, Critchley HO: Factors affecting adequacy of Pipelle and Tao Brush endometrial sampling. BJOG 2008;115:1028-1036.
8.
Yanoh K, Norimatsu Y, Munakata S, Yamamoto T, Nakamura Y, Murata T, Kobayashi TK, Hirai Y: Evaluation of endometrial cytology prepared with the Becton Dickinson SurePath™ method: a pilot study by the Osaki Study Group. Acta Cytol 2014;58:153-161.
9.
Werner M, Von Wasielewski R, Komminoth P: Antigen retrieval, signal amplification and intensification in immunohistochemistry. Histochem Cell Biol 1996;105:253-260.
10.
Ferry J, Farnsworth A, Webster M, Wren B: The efficacy of the Pipelle endometrial biopsy in detecting endometrial carcinoma. Aust NZ J Obstet Gynaecol 1993;33:76-78.
11.
Zorlu CG, Cobanoglu O, Isik AZ, Kutluay L, Kuscu E: Accuracy of Pipelle endometrial sampling in endometrial carcinoma. Gynecol Obstet Invest 1994;38:272-275.
12.
Guido RS, Kanbour-Shakir A, Rulin MC, Christopherson WA: Pipelle endometrial sampling. Sensitivity in the detection of endometrial cancer. J Reprod Med 1995;40:553-555.
13.
Clark TJ, Mann CH, Shah N, Khan KS, Song F, Gupta JK: Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial cancer: a systematic quantitative review. BJOG 2002;109:313-321.
14.
Farrell T, Jones N, Owen P, Baird A: The significance of an “insufficient” Pipelle sample in the investigation of post-menopausal bleeding. Acta Obstet Gynecol Scand 1999;78:810-812.
15.
van Doorn HC, Opmeer BC, Burger CW, Duk MJ, Kooi GS, Mol BW: Inadequate office endometrial sample requires further evaluation in women with postmenopausal bleeding and abnormal ultrasound results. Int J Gynaecol Obstet 2007;99:100-104.
16.
Breijer MC, Peeters JA, Opmeer BC, et al: Capacity of endometrial thickness measurement to diagnose endometrial carcinoma in asymptomatic postmenopausal women: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 2012;40:621-629.
17.
Dreisler E, Poulsen LG, Antonsen SL, et al: EMAS clinical guide: assessment of the endometrium in peri- and postmenopausal women. Maturitas 2013;75:181-190.
18.
Ben-Baruch G, Menczer J, Shalev J, Romem Y, Serr DM: Uterine perforation during curettage: perforation rates and postperforation management. Isr J Med Sci 1980;16:821-824.
19.
Hefler L, Lemach A, Seebacher V, Polterauer S, Tempfer C, Reinthaller A: The intraoperative complication rate of nonobstetric dilation and curettage. Obstet Gynecol 2009;113:1268-1271.
© 2017 S. Karger AG, Basel
2017
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.