Cytological analysis of the distension fluid used during diagnostic office hysteroscopies in patients with suspected endometrial pathology

Objective: Evaluation of the feasibility and usefulness of cytological analysis of the distension fluid used during diagnostic office hysteroscopy in patients with suspected endometrial pathology.

Methods: In 243 consecutive patients undergoing diagnostic hysteroscopy for suspected endometrial pathology a few milliliters of the distension medium used for uterine visualization were collected and sent for cytological analysis. Findings of these "endometrial washings" were compared to visual hysteroscopic impression, endometrial biopsy and uterine histology--when available.

Results: Endometrial washings were considered adequate in 227 patients (93.4%). In 12 cases (5.3%) atypical cells were detected: all of these presented either atypical complex hyperplasia or endometrial cancer at the final histological evaluation of the uterus. Four of the 16 (25%) patients diagnosed with endometrial cancer or atypical complex hyperplasia at the final histopathological analysis of the uterus had inadequate washings. No patient with cancer or atypical hyperplasia had negative cytology.

Conclusions: Collection and analysis of the distension fluid is feasible and, when positive, has a remarkable value in the diagnosis of endometrial cancer and its precursors.

Endometrial cancer; Atypical hyperplasia; Cytology; Hysteroscopy

[1] Greenlee R.T., Murray T., Bolden S., Wingo P.A.: "Cancer statistics, 2000". CA Cancer J. Clin., 2000, 50, 7.

[2] Brandner P., Neis K.J.: "Diagnosis of endometrial cancer and its precursors". Contrib. Gynecol. Obstet., 2000, 20, 27.

[3] Ceci O., Bettocchi S., Pellegrino A., Impedovo L., Di Venere R., Pansini N.: "Comparison of hysteroscopic and hysterectomy findings for assessing the diagnosstic accuracy of office hysteroscopy". Fertil. Steril., 2002, 78, 628.

[4] Clark T.J., Voit D., Gupta J.K., Hyde C., Song F., Khan K.S.: "Accuracy of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia: a systematic quantitative review". JAMA, 2002, 288, 1610.

[5] Garuti G., Sambruni I., Colonnelli M., Luerti M.: "Accuracy of hysteroscopy in predicting histopathology of endometrium in 1500 women". J. Am. Assoc. Gynecol. Laparosc., 2001, 8, 207.

[6] Kurman R.J., Norris H.J.: "Evaluation of criteria for distinguishing atypical endometrial hyperplasia from well-differentiated carcinoma". Cancer, 1982, 49, 2547.

[7] Ferenczy A., Gelfand M.M., T zipris F.: "The cytodynamics of endometrial hyperplasia and carcinoma: A review". Ann. Pathol., 1983, 3, 189.

[8] Kurman R.J., Kalminski P.F., Norris H.J.: "The behavior of endometrial hyperplasia: A long-term study of "untreated" hyperplasia in 170 patients". Cancer, 1985, 56, 403.

[9] Bettocchi S., Selvaggi L.: "A vaginoscopic approach to reduce the pain of office hysteroscopy". J. Am. Assoc. Gynecol. Laparosc., 1997, 4, 255.

[10] Bistoletti P., Hjerpe A.: "Routine use of endometrial cytology in clinical practice". Acta Cytol., 1993, 37, 867.

[11] Byrne A.J.: "Endocyte endometrial smear cytodiagnosis of endometrial carcinoma". Acta Cytol., 1990, 34, 373.

[12] Kashimura M., Baba S., Shinohara M., Kashimura Y., Saito T., Hachisuga T.: "Cytologic findings in endometrial hyperplasia". Acta Cytol., 1988, 32, 335.

[13] Ng A.B.P., Reagan J.W.: "The pathology and cytopathology of micro invasive adenocarcinoma and precursors of endometrial carcinoma". In: Wied G.L., Keebler C.M., Koss L.G., Reagan J.W. (eds). Compendium on Diagnostic Cytology, 6'" ed. Chicago, Tutorials of Cytology, 1990, 80.

[14] Nagele F., O'Connor H., Davies A., Badawy A., Mohamed H., Magos A.: "2500 outpatient diagnostic hysteroscopies". Obstet. Gynecol., 1996, 88, 87.

[15] Schwarzler P., Concin H., Bosch H., Berlinger A., Wohlgenannt K., Collins W.P. et al.: "An evaluation of sonohysterography and diagnostic hysteroscopy for the assessment of intrauterine pathology". Ultrasound Obstet. Gynecol., 1998, 11, 337.

[16] Colafranceschi M., Bettocchi S., Mencaglia L., van Herendael B.J.: "Missed hysteroscopic detection of uterine carcinoma before endometrial resection: report of three cases". Gynecol. Oneal., 1996, 62, 298.

[17] Vilos G.A., Harding P.G., Silcox J.A., Sugimoto AK., Carey M., Ettler H.C.: "Endometrial adenocarcinoma encountered at the time of hysteroscopic endometrial ablation". J. Am. Assoc. Gynecol. Laparosc., 2002, 9, 40.

[18] Agostini A., Cravello L., Bretelle F., Demaisonneuve A.S., Roger V., Blanc B.: "Risk of discovering endometrial carcinoma or atypical hyperplasia during hysteroscopic surgery in postmenopausal women". J. Am. Assoc. Gynecol. Laparosc., 2001, 8, 533.

[19] Vasile C., P iazza M.: "Accuracy of office hysteroscopy in the diagnosis of endometrial hyperplasia". Clin. Exp. Obstet. Gynecol., 2003, 30, 22.