Cytologic screening for gynecologic cancer.

In the past 30 years there has been no improvement in the five-year survival rate for endometrial carcinoma. Any change comparable to improved survival in cervical carcinoma will be accomplished only by similar detection of the early asymptomatic and precursor lesions of endometrial carcinoma. Reasons why the conventional Pap smear taken today has only a 25% to 50% screening accuracy for endometrial carcinoma are explained along with methods to improve these percentages. With our technic, endometrial aspiration cytology has the capabilities of screening for varying stages of endometrial hyperplasia that are considered precursors of endometrial carcinoma, as well as an 85% accuracy rate for screening detection of established endometrial carcinoma. These technics and methods, along with accompanying photographs and photomicrographs of representative cytologic and histologic specimens of varying representative lesions are shown.

An acceptable yearly screening device for endometrial carcinoma.

PIP: Endometrial carcinoma is a disease of menopausal and postmenopausal women with 74% of cases occurring between the ages of 50-69 years and 16% at age 70 or older. Recent reports suggest an increase in the frequency of the lesion and occurrence at an earlier age. Any single test by most of the conventional methods will miss about 50% of the carcinomas of the endometrium. To obtain greater accuracy in diagnosis, it is necessary to obtain large numbers of well-preserved cells directly from the endometrial cavity. Cervical patency should be proved in the examination of all postmenopausal women. The device described uses a silicone rubber tube 33.5 cm in length and 2 mm in diameter. A wire stylet for stiffness and a rounded plastic tip facilitate passage through the sometimes stenotic cervical canal. Near the tip many small holes permit aspiration of endocervical secretions. A plastic collar around the tubing facilitates the aspiration. An aspirating syringe adapter is needed. After conventional Pap smears are obtained the aspirating tube is passed into the uterus. Little or no pain is produced. Negative pressure for aspiration is obtained with a syringe. The contents of the aspirating tube are expelled onto a slide. The slide preparations are immediately fixed in a bottle of absolute alcohol containing 3% glacial acetic acid. The acid lyses most red blood cells. This method was used in 983 outpatients and 500 hospitalized patients. There were only 5 patients in whom the endometrial aspirator could not be passed, due to previous cervical trauma in 3 and vaginal atrophy and distortion in 2. No uterine perforations or infections occurred. There were no positive tests for carcinoma in the 983 outpatients. Endometrial carcinoma was diagnosed histologically in 32 of the 500 hospitalized patients. IN 27 of these 32 cases the endometrial carcinoma had been detected by cytological examination of the aspirate. There were 5 carcinoma cases in which the aspirate did not show malignant cells. In 3 of them external radiation had been given prior to surgery and some residual cancer was found in the hysterectomy specimen. Excessive blood on the slide had prevented adequate cytologic evaluation in the other 2. In 6 cases adenocarcinoma was suspected from the examination of the aspirate but not found histologically. 4 of them showed abnormal endometrial curettings. Polyps were found in 3 and hyperplasia in 1. 8 cases of in situ or early invasive carcinoma of the cervix were discovered. Results show that the method is safe and accurate to an 84.4% degree for detecting endometrial adenocarcinoma. In an accompanying discussion, better fixation of material on slides was suggested. Annual mass population screening by this method was not considered practical. Others have depended on a jet wash of the endometrium and on endometrial biopsies to obtain material for histologic study, but many patients do not like having the needed dilatation and fail to return for reexaminations.^ieng