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Items 1-18 of 18 |
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One page. |
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Pap smears in women with endometrial carcinoma.
Gu M, Shi W, Barakat RR, Thaler HT, Saigo PE.
Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA. [email protected]
OBJECTIVE: To correlate Pap smear findings with the histology of endometrial carcinoma and stage of the disease. STUDY DESIGN: Between 1995 and 1998, 76 women with endometrial carcinoma, having had Pap smears done within two to three months of hysterectomy at Memorial Sloan-Kettering Cancer Center, formed the basis for this study. All Pap smears and histologic sections were reviewed. RESULTS: Thirty-four patients had normal Pap smears (45%), and 42 had abnormal ones (55%). The mean age of the two groups was 65.1 and 65.2 years, respectively. Histologic subtypes included 44 International Federation of Gynecology and Obstetrics (FIGO) grade 1 endometrioid adenocarcinoma (low grade) and 32 high grade carcinomas, including 19 FIGO grade 2 or 3 endometrioid adenocarcinomas, 5 papillary serous carcinomas (PSC), 2 clear cell carcinomas (CC), 1 adenosquamous carcinoma, 3 endometrioid adenocarcinomas mixed with PSC and 2 endometrioid adenocarcinomas mixed with CC. The proportions of patients with low and high grade tumors with abnormal Pap smears were 43% (19/44) and 72% (23/32), respectively (P=.01). The proportions of patients with abnormal Pap smears and no myometrial invasion, invasion of <50% and >50% myometrial thickness were 40% (8/20), 62% (26/42) and 57% (8/14), respectively (P =.27). Vascular invasion was identified in 56% (9/16) of patients with abnormal Pap smears and in 55% (33/60) of patients with normal ones (P = .93). The proportions of patients having abnormal Pap smears with stage I and stages II, III or IV disease were 48% (30/62) and 86% (12/14), respectively (P =.01). CONCLUSION: Although the Pap smear is not a sensitive screening test for endometrial cancer and a negative Pap smear does not rule it out, this study revealed that abnormal Pap smears are significantly associated with high grade of tumor and stage II-IV endometrial carcinoma. However, they are not associated with patient age, depth of myometrial invasion or vascular invasion.
PMID: 11480718 [PubMed - indexed for MEDLINE]
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Significance of cytologically normal endometrial cells in cervical smears from postmenopausal women.
Sarode VR, Rader AE, Rose PG, Rodriguez M, Abdul-Karim FW.
Department of Pathology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA.
OBJECTIVE: To determine the significance of cytologically normal endometrial cells in cervicovaginal (CV) smears from postmenopausal women over age 55 years. STUDY DESIGN: From January 1995 to January 1998, 220 women had CV smears demonstrating cytologically normal endometrial cells. The menopausal status, hormone replacement therapy (HRT) and information related to subsequent CV smears and endometrial sampling within 12 months of the initial diagnosis was recorded. RESULTS: Eighty-one of the 220 cases (36.8%) had histologic sampling of the endometrium. Thirty-four of 81 (42%) showed no endometrial pathology. Endometrial pathology was identified in 28 of 81 (34%), of which 19 were endometrial polyps (23.4%), 4 were endometrial hyperplasia (4.9%), 4 were endometrial carcinoma (4.9%) and 1 was a leiomyoma (1.2%). Nineteen (23.4%) were insufficient for diagnosis. Ninety-one of 220 women were on HRT, and 129 were not. In the group without HRT, endometrial disease was identified in 22/51 (43%) cases as compared to 6/30 (20%) in the group with HRT (P < .001). Endometrial carcinoma was identified in three (5.8%) cases and one (3.3%) case without and with HRT, respectively. CONCLUSION: Although the finding of normal endometrial cells in Pap smears from postmenopausal women was without any clinical significance in the majority of women in this study, in a small number it was associated with endometrial hyperplasia and carcinoma. Women who were not on HRT had a higher incidence of endometrial pathology.
PMID: 11284298 [PubMed - indexed for MEDLINE]
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Peritoneal washings in endometrial carcinoma. A study of 298 patients with histopathologic correlation.
Gu M, Shi W, Barakat RR, Thaler HT, Saigo PE.
Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
OBJECTIVE: To correlate findings of peritoneal washings in patients with endometrial carcinoma with histologic parameters. STUDY DESIGN: Between 1995 and 1998, 298 women with endometrial carcinoma were treated by hysterectomy with intraoperative peritoneal washings (PW) at Memorial Sloan-Kettering Cancer Center. All cytology and pathology slides were available for review. Pathologic parameters of hysterectomy specimens were evaluated and correlated with the findings of PW. RESULTS: Thirty-two patients (10.7%) had abnormal PW. Two hundred sixty-two had endometrioid adenocarcinoma; 26 of them had abnormal PW (10.0%). Thirty-six patients had other histologic subtypes (papillary serous carcinoma, clear cell carcinoma and adenosquamous carcinoma), and six of them had abnormal PW (16.7%). The incidence of abnormal PW in the two groups was not significantly different (P = .78). Among 26 patients with endometrioid adenocarcinoma and abnormal PW, there were 17 cases (9.9%) of International Federation of Gynecology and Obstetrics (FIGO) grade 1, 7 (12.7%) of grade 2 and 2 (5.7%) of grade 3 (P = .56). Ten cases (14.9%) had no myometrial invasion, 10 (7.0%) had myometrial invasion of < or = 50% of myometrial thickness, and 6 (11.5%) had invasion of > 50% of myometrial thickness (P = .18). Vascular invasion was present in 8 cases (14.8%) and absent from 17 (8.2%) (P = .14). Eighteen patients (7.6%) had stage I/II disease, and eight patients (30.8%) had stage III/IV disease (P = .001). Among 298 patients, cervicovaginal smears performed before surgery were available for review in 76. Five of the 7 patients (71.4%) with abnormal PW and 37 of the 69 patients (53.6%) with normal PW had abnormal Pap smears (P = .45). CONCLUSION: Abnormal PW did not correlate with histologic subtypes, FIGO grade, depth of myometrial invasion, vascular invasion or abnormal Pap smears. A significantly higher incidence of abnormal PW was associated with stage III/IV disease.
PMID: 11015980 [PubMed - indexed for MEDLINE]
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Cytohistologic correlation between AGUS and biopsy-detected lesions in postmenopausal women.
Obenson K, Abreo F, Grafton WD.
Department of Pathology, Louisiana State University Medical Center, Shreveport 71130, USA.
OBJECTIVE: To evaluate histologic findings in patients aged 50 and older whose cervical smears revealed atypical glandular cells of undetermined significance (AGUS). STUDY DESIGN: Computerized records spanning a four-year period were retrospectively analyzed. Thirty patients over age 50 had cervical smears interpreted as AGUS and had follow-up biopsies within 12 months following the abnormal smear. The most important histologic diagnosis from the biopsy specimens was correlated with the subcategory of the cervical smear. RESULTS: Five smears interpreted as AGUS, favor reactive, revealed abnormal histology in four cases: three endometrial polyps and one squamous carcinoma. Two smears interpreted as AGUS, favor dysplasia, revealed squamous intraepithelial lesions on biopsy in both cases. Seventeen smears interpreted as AGUS, favor endometrial cells, revealed abnormal histology in 13 cases: 1 endocervical polyp, 6 endometrial polyps, 3 endometrial hyperplasias and 3 adenomyosis. Six patients with smears interpreted as AGUS, unclassifiable, revealed abnormal histology in five cases: two endocervical polyps, one endometrial polyp, one endometrial carcinoma and one ovarian carcinoma. CONCLUSION: The presence of AGUS in cervical smears from women over 50 was highly predictive of abnormal lesions detected by histologic examination. Although three cancers were detected on histologic follow-up, the most common lesions detected were endometrial polyps.
PMID: 10667158 [PubMed - indexed for MEDLINE]
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Cytologic detection of cervical and endometrial carcinoma with other genital tract involvement.
Kobilkova J, Lojda Z, Dohnalova A, Havrankova E.
Clinic of Gynecology and Obstetrics, First School of Medicine, Charles University, Prague, Czech Republic.
OBJECTIVE: To investigate the possibility of a correct cytologic diagnosis of cervical and endometrial carcinoma with other genital organ involvement. STUDY DESIGN: From uteri removed during hysterectomy due to cervical (33 cases) and endometrial (44 cases) cancer, samples were taken by cytobrush or spatula from the ectocervix, endocervix and endometrium of uteri opened longitudinally. Smears and cytosediments were stained by the Papanicolaou polychrome method. Moreover, acid beta-galactosidase activity was demonstrated in serial cytosediments by the indigogenic method of Lojda. From quenched tissue samples taken from the same sites as those for cytology, a series of cryostat sections was prepared and stained by hematoxylin and eosin or azure A, or subjected to the reaction for acid beta-galactosidase. RESULTS: In 17 of 33 patients with cervical cancer, the same type of cancer was also found in smears of the endocervix and endometrium. In six patients the type of cancer was different. Of 44 patients with endometrial cancer, 16 had an endocervical malignancy of the same type. In seven cases the type of cancer was different. The reaction for acid beta-galactosidase helped in the differentiation between squamous (negative reaction in cancer cells) and cylindrocellular (positive reaction) cancer in cytologic preparations. CONCLUSION: Before treatment, it is necessary to determine if there is involvement of the endocervix in endometrial cancer and of the endometrium in cervical cancer. Routine cytologic examination supplemented by the reaction for acid beta-galactosidase proved to be useful for this purpose.
PMID: 10667153 [PubMed - indexed for MEDLINE]
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Experience with Endopap endometrial sampling in the cytodiagnosis of endometrial carcinoma and its precursor lesions. I. A correlative cytologic-histologic-hysteroscopic diagnostic pilot study.
Suprun HZ, Taendler-Stolero R, Schwartz J, Ettinger M.
Department of Pathology and Cytology, Nahariyya Government and Regional Medical Center of the Western Galilee, Israel.
From June 1 through December 3, 1991, 146 women were referred to the Gynecology Outpatient Clinic of Nahariyya Medical Center for uterine bleeding and pathologic conditions. Their ages ranged from < 40 (26 patients) to > or = 60 (18 patients), with 60 (41%) in the 40-49 age group. An Endopap endometrial sampling pilot study was undertaken to find a correlative index between cytologic, histologic and hysteroscopic sampling methods as well as to investigate the possibility that Endopap sampling could avoid excessive use of nontherapeutic dilation and curettage. In 118 patients for whom concomitant cytologic and histologic specimens were available there was no statistically significant difference between the number of correct cytologic and histologic diagnoses of intrauterine pathology. Cytodiagnostic accuracy of the Endopap samples was expressed in terms of sensitivity (68.2%), specificity (80.7%), predictive value of a malignant test result (100%) and predictive value (PV) of an abnormal (hyperplasia) test result (73.2%). The lower values for sensitivity, specificity and PV in this study as compared with those in the literature were probably due to three attenuating factors: the relatively small number of patients (146), the fact that the cytodiagnostic accuracy for hyperplasia and precursor lesions of endometrial carcinoma is significantly lower than for histologic diagnosis, and the presence of 15 (10.3%) inadequate cytologic specimens. The results did tend to concur with the range of reported results. It is recommended that Endopap sampling be employed in cases of medically and anatomically contraindicated dilation and curettage--e.g., cervical canal stenosis and intrauterine adhesions (Asherman's syndrome)--in monitoring perimenopausal and postmenopausal patients on estrogen replacement therapy and in obese women, diabetics and hypertensives at risk of developing endometrial hyperplasia. The study also showed that the combined hysteroscopic and Endopap techniques could result in increased rates of sensitivity and specificity.
Publication Types:
PMID: 8191819 [PubMed - indexed for MEDLINE]
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Endocyte endometrial smears in the cytodiagnosis of endometrial carcinoma.
Byrne AJ.
Department of Pathology, University of Ottawa, Douglass Laboratory Services, Ottawa, Ontario.
The cytologic diagnosis of endometrial cancer using material obtained with the Endocyte endometrial sampler was assessed for 874 patients. The samples obtained were smeared directly on slides for fixation and staining; the smears were more difficult to assess than cervicovaginal smears, however, due to the presence of blood, the small size and density of the cells and the flattened three-dimensional architecture of the tissue fragments obtained. Only 8.2% of the samples were classified as inadequate; repeat sampling in some of those cases produced diagnostic material. All 12 cases of carcinoma (including one case in a woman less than 40 years of age) were diagnosed by cytology as malignant; however, the original cytologic sample in one of those cases was inadequate. For the diagnosis of benign versus malignant, cytology had a sensitivity of 92%, a specificity of 100% and predictive value of 100%. Cytology also diagnosed as suspicious the smears from 5 of 13 cases of endometrial hyperplasia and 2 of the 9 cases of endometrial polyps. The cytologic findings for benign and malignant samples are described and illustrated in detail. Relative to other endometrial sampling devices, the Endocyte is inexpensive and was easily used by the gynecologist and well tolerated by the patients, with no complications and minimal discomfort.
PMID: 2343695 [PubMed - indexed for MEDLINE]
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Cytologic features of endometrial papillary serous carcinoma.
Kuebler DL, Nikrui N, Bell DA.
Division of Cytopathology, James Homer Wright Pathology Laboratories, Massachusetts General Hospital 02114.
Endometrial papillary serous carcinoma (EPSC) is an uncommon variant of endometrial carcinoma that histologically resembles ovarian serous carcinoma and has an aggressive clinical course. The cytomorphologic features of 17 patients with histologically confirmed EPSC of the endometrium were reviewed and compared with those of 20 patients with histologically typical endometrial adenocarcinoma (TEC). Preoperative cervicovaginal Papanicolaou smear results were available from 14 of the 17 patients with EPSC; 10 (71%) were positive, 1 (7%) was suspicious and 3 (21%) were negative for malignancy. Initial cervicovaginal smear results were available from all 20 patients with TEC; 7 (35%) were positive, 4 (20%) were atypical or suspicious and 9 (45%) were negative for malignancy. Twelve patients with EPSC had peritoneal washings or fluids examined; seven were positive and five negative. Twelve patients with TEC had peritoneal washings or fluids examined; two (17%) were positive and ten (83%) were negative. The cervicovaginal smears from patients with EPSC revealed numerous large tumor cells (with prominent nucleoli) frequently arranged in papillary clusters with background necrosis and, in two cases, amorphous material suggestive of psammoma bodies. In contrast, the smears of patients with TEC showed small to medium-sized cells with extensive phagocytosis and many background histiocytes. The diagnosis of EPSC should be considered when the cervicovaginal smear contains numerous papillary groups of large tumor cells with macronucleoli but without prominent phagocytosis, especially when structures suggestive of psammoma bodies are present. The peritoneal fluids in these patients are more often positive than in patients with TEC, a finding consistent with the propensity of EPSC to involve peritoneal surfaces.
PMID: 2916358 [PubMed - indexed for MEDLINE]
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Diagnosis of endometrial carcinoma and its precursors by means of cytologic examination of jet-washing material.
Pacifico E, Miraglia M, Miraglia F.
Experience with cytologic examination of 138 consecutive jet washings showed the value of the technique as a method of screening for endometrial carcinoma in symptomatic and at-risk patients. In the 127 adequate specimens obtained (92%), all 16 endometrial carcinomas were diagnosed cytologically. The necessity of physician experience in sampling as well as good cytopreparatory techniques in the use of jet washings is emphasized. A dual preparatory routine, including the use of Millipore filter preparations to evaluate cellularity and the type of clusters and the use of smears on chilled slides to evaluate cellular details, was found to be optimal.
PMID: 6959451 [PubMed - indexed for MEDLINE]
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Clinical experience with a new endometrial cell sampling kit (Isaacs curity endometrium cell sampler) in the early detection of endometrial cancer.
Feichter GE, Tauber PF, Landowski J.
The Isaacs Curity Endometrium Cell Sampler (ICECS) is a new device for the detection of precancerous lesions of the endometrium and asymptomatic endometrial carcinoma. Our clinical experience with the ICECS in a group of 136 women 45 years of age and older with an increased risk for endometrial cancer showed that it was easily used, caused minimal discomfort to the patients and gave good results. The cytologic smears were acceptable for screening in 130 of the 136 cases (95.6%). Normal premenopausal or postmenopausal endometrial cells were found in 100 cases. Hyperplastic changes were found in 18 cases. Carcinoma were diagnosed in 12 cases; all were proven by histologic examination of tissue obtained by curettage. Our results indicate that the new device is valuable for mass cytologic screening for endometrial cancer.
PMID: 6952714 [PubMed - indexed for MEDLINE]
Direct intrauterine sampling: the IUMC Endometrial Sampler.
Tao LC.
Indiana University School of Medicine, Indianapolis, USA.
Endometrial cytology has been studied for more than 25 years, and a variety of cytologic devices have been developed for direct sampling of the endometrium. The quality of endometrial samples procured by various devices is markedly different and greatly affects the diagnostic accuracy. A new endometrial sampling device, the IUMC Endometrial Sampler, was developed at the Indiana University Medical Center and approved by the Food and Drug Administration for general medical use. This device is intended for the early detection of endometrial carcinoma and its precursors. It can be used to monitor the endometrial condition of patients receiving estrogen replacement therapy or tamoxifen. It is also useful for the procurement of uncontaminated endometrial samples for microbiologic studies from patients with suspected endometritis. It has the potential to be used for endometrial dating for patients with infertility disorders. In our clinical trials and sampling tests using hysterectomy specimens, adequate and representative endometrial samples without contamination from endocervix and vagina were consistently obtained by this device. The procedure of endometrial sampling using this device and the preparation techniques for endometrial brushing specimens are discussed and illustrated.
Publication Types:
PMID: 9258625 [PubMed - indexed for MEDLINE]
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Cytopathological changes in human cervix and endometrium following prolonged retention of copper-bearing intrauterine contraceptive devices.
Misra JS, Engineer AD, Tandon P.
Department of Obstetrics and Gynaecology, K.G.'s Medical College, Lucknow, India.
Since 1971, cytological evaluation of cervical smears and endometrial aspirates was carried out in 604 women wearing CuT200 intrauterine contraceptive devices (IUDs) for periods ranging from 6 mo to 15 yr. No cases of cervical neoplasia or endometrial carcinoma were encountered, even after continuous use of the device for 15 years. Dysplastic cervical smears were, however, found in 45 postinsertional smears, and endometrial hyperplasia was detected in seven aspirates; in no cases was the dysplasia or hyperplasia higher than of moderate degree. Thirty-nine of the 45 women with postinsertional dysplastic smears were followed for 3-4 yr; in no case did the lesion progress to a higher grade or to frank malignancy. However, persistence and recurrence of dysplasia were seen in 10 women, necessitating removal of the IUDs. The incidence of cervical dysplasia and endometrial hyperplasia was found to be much higher when the IUDs had been changed than when the original devices were worn continuously. The rate of removal of IUDs because of persistent or recurring dysplasia was also much higher in the former group. Since no pregnancies were reported in any of the women wearing the original device for as long as 15 yr, we do not advocate the practice of changing the device at the end of 3 yr for maintaining contraceptive efficacy as recommended by the manufacturers; instead, we recommend the uninterrupted retention of the original device for periods not longer than 5 yr in view of occurrence of endometrial hyperplasia in two 6-yr wearers.
PMID: 2791830 [PubMed - indexed for MEDLINE]
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The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis.
Dijkhuizen FP, Mol BW, Brolmann HA, Heintz AP.
Department of Obstetrics and Gynecology, Rijnstate Hospital, Arnhem, The Netherlands.
BACKGROUND: Endometrial assessment by means of biopsy or sampling of endometrial cells is a minimally invasive alternative for dilatation and curettage (D&C) or hysteroscopy. The use of this technique is believed to reduce the cost of the diagnostic work-up for abnormal uterine bleeding without reducing accuracy. Because the authors were not aware of any systematic review of this test, they performed a meta-analysis to assess the accuracy of endometrial sampling devices in the detection of endometrial carcinoma and atypical hyperplasia. METHODS: The authors searched the literature for studies published between 1966 and 1999 comparing the results of endometrial sampling with findings at D&C, hysteroscopy, and/or hysterectomy. They found 39 studies that included 7914 women. For each study, the fraction of patients was calculated in which endometrial sampling failed. Furthermore, the authors calculated the fraction of cases of endometrial carcinoma and atypical hyperplasia that were identified correctly as well as the fraction of women in whom these diseases were diagnosed false positively. RESULTS: The detection rate for endometrial carcinoma was higher in postmenopausal women compared with premenopausal women. In both postmenopausal and premenopausal women, the Pipelle was the best device, with detection rates of 99. 6% and 91%, respectively. For the detection of atypical hyperplasia, there was only one study that reported explicitly on postmenopausal women, thereby hampering the possibility of subgroup analysis. Again, the Pipelle was the most sensitive technique with a sensitivity of 81%. The specificity of all devices was > 98%. CONCLUSIONS: Endometrial biopsy with the Pipelle is superior to other endometrial techniques in the detection of endometrial carcinoma and atypical hyperplasia. The accuracy of the Pipelle is higher in postmenopausal women compared with premenopausal women. Copyright 2000 American Cancer Society.
Publication Types:
PMID: 11042572 [PubMed - indexed for MEDLINE]
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The effectiveness of the Masterson curette in sampling the endometrial cavity.
Reddington L, Hernandez E, Balsara G, Hughes D, Anderson L, Heller PB.
Department of Obstetrics, Gynecology, Medical College of Pennsylvania, Philadelphia 19129, USA.
The Masterson curette was used to sample the endometrial cavity of 25 women prior to scheduled hysterectomy for benign or malignant pathology. Adequate amount of tissue was obtained in 20 (87%) of 23 patients who did not have endometrial atrophy. The Masterson curettage detected all seven cases of endometrial hyperplasia or adenocarcinoma for a sensitivity of 100%. However, the Masterson curette does not sample the entire endometrial cavity. If abnormal uterine bleeding persists despite normal histology on curettings obtained with the Masterson or other endometrial sampling device, hysteroscopy is recommended.
PMID: 8558620 [PubMed - indexed for MEDLINE]
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Accuracy of pipelle endometrial sampling in endometrial carcinoma.
Zorlu CG, Cobanoglu O, Isik AZ, Kutluay L, Kuscu E.
Division of Gynecologic Oncology, Dr. Zekai Tahir Burak Women's Hospital, Ankara, Turkey.
In this prospective study, we compared the histological results of Pipelle endometrial sampling (PES) with that of hysterectomy to examine whether endometrial sampling with the Pipelle device can accurately diagnose endometrial carcinoma. PES was performed in 26 patients with known endometrial carcinoma whose initial therapy consisted of hysterectomy. Discomfort and pain during the biopsy were reported to be mild by 22 patients, moderate by 3 patients and severe by only 1 patient. All of the samples were found to be adequate. Twenty-four of 26 PES confirmed endometrial carcinoma, a correlation of 95%, and the histological grade reported on PES agreed with that of hysterectomy specimens in 87.5% of the patients. On the other hand, the tumor grade in the specimens obtained at dilation and curettage correlated with hysterectomy specimens in 95% of the patients. We conclude that Pipelle is an accurate device in patients with endometrial carcinoma.
PMID: 7851814 [PubMed - indexed for MEDLINE]
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Diagnostic methods of early detection of endometrial hyperplasia and cancer.
Pace S, Grassi A, Ferrero S, Figliolini N, Catania R, Labi FL, Pachi A, Figliolini M.
2nd Department of Obstetrics e Gynecology, Rome University La Sapienza, Italy.
Endometrial carcinoma is the most frequent genital neoplasia in women. Our own experience is based on a group of 3310 patients who were studied between 1985 and April 1994. In 2148 cases, equivalent to 56.4%, hysteroscopy was performed because of the presence of abnormal uterine bleeding (AUB). We found 672 endometrial hyperplasia (601 low risk-71 high risk) and 93 endometrial carcinoma. According to our experience we can assert that: hysteroscopy allows the measurement of the extension of the intracavitary neoplastic pathology and the definition of its topographic map; it is the only method that allows a target biopsy; it facilitates the evaluation of the extension of the neoplasia in the cervical canal, with the help of a deep biopsy into the cervical tissue (as proposed by La Sala) increasing its diagnostic accuracy.
PMID: 8549603 [PubMed - indexed for MEDLINE]
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Detection of occult endometrial carcinoma.
Koss LG.
Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
Endometrial carcinoma is commonly diagnosed as a consequence of abnormal uterine bleeding. In a study published in 1962, it was documented that endometrial cancer may be detected by vaginal pool smears in asymptomatic postmenopausal women. As a consequence of these observation, a systematic search for occult endometrial carcinoma was initiated in 1979, supported by a contract from the National Cancer Institute. The techniques used in this study and the problems encountered in the diagnosis of occult endometrial carcinoma will be discussed. Within 3-1/2 years of this study encompassing 2,586 peri- or postmenopausal women 16 occult endometrial carcinomas were discovered by direct endometrial sampling. Two carcinomas, missed on initial screening, were subsequently documented in this cohort, for a prevalence rate of 6.96 per 1,000. The incidence data based on follow-up examination of 1,754 women was 1.71 per 1,000 woman-years. An elaborate epidemiologic questionnaire was evaluated. Contrary to some prevailing views, obesity, hypertension, and diabetes failed to reach statistical significance as risk factors. The only risk factor of statistical value was delay in the onset of menopause past age 49, observed in about 50% of the cohort. It was noted that the administration of estrogens to women in Quetelet Index groups below means was more likely to be associated with carcinoma than in women in higher Quetelet groups but, again, the difference was not statistically significant. It was noted that in spite of an active search for endometrial hyperplasias, the rate of these lesions was nearly identical to the prevalence and incidence rates for carcinoma. It was postulated that some or perhaps most, endometrial carcinomas in postmenopausal women are not preceded by hyperplasia but originate ab initio in the endometrium.
Publication Types:
PMID: 8747392 [PubMed - indexed for MEDLINE]
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Endometrial and endocervical brushing techniques with a Medhosa cannula.
Jimenez-Ayala M, Vilaplana E, Becerro de Bengoa C, Zomeno M, Moreno S, Granados M.
A new technique for obtaining endometrial material using the Medhosa Cannula is described. This method is also useful to obtain samples from the endocervix. The Medhosa Cannula is made of flexible plastic. It is 30 cm long and has thin fins on its distal end which, guided by an introduction cone, permit endometrial and endocervical brushing. Six hundred cases are reported. Concomitant histopathological studies were performed in 40 per cent of the patients. There were two false negative cytologic reports (0.88%) and one false positive (6.66%). This is a simple, rapid, innocuous and economical technique, thus fulfilling the prerequisites for routine cytodiagnostic methods. Adequate material was always obtained.
PMID: 1061473 [PubMed - indexed for MEDLINE]
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Items 1-18 of 18 |
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One page. |
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