Assessment of Reliability of Endometrial Brush Cytology to Determine the Etiology of Abnormal Uterine Bleeding and Postmenopausal Bleeding

Abstract

Objective: To demonstrate diagnostic efficacy of endometrial cytologic sampling for detection of endometrial pathologies (endometrial hyperplasias and cancers), by comparing endometrial full curettage and endometrial cytologic smear pathologic results performed in patients with abnormal uterine bleeding. Materials and methods: Totally 109 reproductive and postmenopausal women with abnormal uterine bleeding who applied our clinic between the dates January 2005-June 2010 were included in the study. After measurement of endometrial thickness by transvaginal ultrasound, patients were treated initialy with endometrial cytologic sampling using endometrial brush then endometrial full curettage using sharp curette. Pathology and cytology reports were evaluated retrospectively by reviewing patient's files. Results: The most frequent diagnoses in endometrial cytologic specimens obtained by endometrial brush was nondiagnostic with a rate of 73.7%(n:42) and 53.8%(n:28) in postmenopausal women and reproductive period women, respectively. When all the patients were analysed together, the diagnosis was non-diagnostic in 64.2%(n:70) (38.5% postmenopausal, 25.7% premenopausal) of endometrial cytologic samples. Cytologic assessment was resulted as sufficient in only 35.8% (n:39) of the cases. Endometrial full curettage pathologic diagnoses were resulted as insufficient in 56.1%(n:32) of postmenopausal patients and 9.6%(n:5) of reproductive period cases. The second most frequent diagnosis was endometrial polyp in 13(22.8%) patients in postmenopausal period, whereas the most frequent diagnoses in reproductive period were reported as endometrial polyp in 18 (34.6%) and secretory endometrium in 12(23.1%) patients. When the full curettage was considered as golden standard method with respect to sample sufficiency; the sensitivity of endometrial cytologic evaluation in postmenopausal patients with regard to sample sufficiency was found as 36%, spesificity 81.3%, positive predictive value 60.0%, negative predictive value 61.9%; the values were found as 44.7%, 40.0%, 87.5%, 7.1%, respectively, in reproductive period patients. Conclusions: In both reproductive and postmenopausal period patients; endometrial cytology does not appear as a method which can be used alone for detection of premalignant or malignant lesions of endometrium, due to high rate of material inadequacy obtained by it compared to endometrial full curettage biopsy.