Liquid-based endometrial cytology associated with curettage in the investigation of endometrial carcinoma in postmenopausal women.

OBJECTIVE: The aim of this study was to investigate the diagnostic accuracy of liquid-based endometrial cytology in postmenopausal women, in comparison with histology. MATERIALS AND METHODS: There were 790 postmenopausal women scheduled for hysteroscopy enrolled in this study. After providing informed consent, all patients proceeded sequentially through endometrial cytology, hysteroscopy, and then dilatation and curettage (D&C). Cytology sampling was performed by brushing the uterus cavity using SAP-1 and the sample was prepared to liquid-based smear using SurePath technology. The slides were stained by Papanicolaou method. All cytological diagnoses were correlated with the D&C histological diagnoses. RESULTS: Cytohistological correlations were possible in 567 (71.8%) patients: the D&C was inadequate in 204 (25.8%) patients; the cytology was inadequate in 32 (4.1%) patients; and both were inadequate in 13 (1.6%) patients. SAP-1 provided more sufficient material for cytology than D&C can for histology (p < 0.001). Taking atypical hyperplasia and endometrial carcinoma as a positive result, the diagnostic accuracy of liquid-based endometrial cytology was 81.5%; sensitivity was estimated at 75.9%, specificity at 83.3%, positive predictive value at 59.1% and negative predictive value at 91.6%. CONCLUSION: Liquid-based endometrial cytology can be considered a useful method in the detection of endometrial pathology in postmenopausal women.

[Screening and sampling of endometrial carcinoma accuracy of the endometrial cytology test for the screening of endometrial cancer].

OBJECTIVE: To evaluate the accuracy of endometrial cytology test (ECT) for the diagnosis of endometrial cancer or precancerous lesions and then discuss the value of ECT as a screening tool for endometrial cancer.Secondly, to investigate related characteristics and independent risk factors of epidemiology of endometrial carcinomas and atypical endometrial hyperplasia to advise proper crowd for endometrial carcinomas screening and monitoring. METHODS: Totally 1717 preoperative questionnaires on hysteroscopy + dilation & curettage, histopathology and endometrial cytological tests in Peking University First Hospital, People's Hospital of Beijing Daxing District and Beijing Cancer Hospital, from March 2009 to May 2013 were completed. Histopathologic diagnoses were used as the gold standard for determining the accuracy of ECT.Extrapolation: applied binary logistic regression method to narrow down the risk factors of histopathology and endometrial cytological examination. RESULTS: Satisfaction rate of cytological specimens and pathological specimens were 96.45% (1656/1717) and 91.44% (1570/1717), respectively. ECT provided sufficient material for the diagnosis significantly more often than histopathology (P < 0.05). For the ECT diagnosis of endometrial cancer: accuracy was estimated at 88.2%, sensitivity at 87.3%, specificity at 88.3%, positive predictive value (PPV) at 41.9%, negative predictive value (NPV)at 98.6%.Univariate analysis revealed that risk factors of diagnosis of endometrial carcinomas and atypical hyperplasia of histopathology were included:body mass index (BMI) ≥ 25 kg/m(2), age ≥ 40 years old, diabetes mellitus, hypertension, menopause, family history of malignant tumor (all P < 0.10). Multifactor analysis revealed that the independent risk factors were included:BMI ≥ 25 kg/m(2), age ≥ 40 years, menopause and family history of malignant tumor (all P < 0.05). CONCLUSIONS: The results of the current study indicated that the accuracy of ECT for the diagnosis of endometrial cancer was high.Furthermore, ECT could be a useful tool for the screening of endometrial cancer.Independent risk factors of endometrial carcinomas and atypical endometrial hyperplasia including:age over 40 years, BMI ≥ 25 kg/m(2), menopause and family history of malignant tumor.

[Evaluation of complications of different operation modes in endometrial cancer].

OBJECTIVE: To analyze the postoperative complications in patients with endometrial carcinoma undergoing surgical operation in different modes and to explore the surgical safety of retroperitoneal lymph node dissection. METHODS: Two hundred and nineteen patients with endometrial cancer treated in our hospital between May 2006 and April 2012 were included in this study. Their clinicopathological data were retrospectively analyzed. Among them, 65 patients received total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH+BSO group), 54 patients received TAH and BSO and pelvic lymph node dissection (PLX group), and 100 patients received TAH and BSO and PLX and para-aortic lymph node dissection (PALX group). The surgical procedures and postoperative complications in different operation modes were analyzed. RESULTS: The operation time was (114.84 ± 6.45) min in the TAH+BSO group, (182.94 ± 6.62) min in the PLX group, and (188.27 ± 5.77) min in the PALX group. The operation time in the TAH+BSO group was significantly shorter than that in the PLX and PALX group (P < 0.001). The amount of blood loss was (222.97 ± 38.42) ml in the TAH+BSO group, (311.80 ± 21.62) ml in the PLX group, and (391.51 ± 53.20) ml in the PALX group. respectively. The amount of blood loss in the TAH+BSO was significantly less than that in the PLX and PALX group (P = 0.009). Lymphedema of the lower extremities was the most frequent complication of retroperitoneal lymph node dissection and the incidence rate was 31.8%. Lymphocyst was the second frequent complication, with an incidence rate of 27.3%. The incidence rate of ileus in the PALX group was significantly higher than that in the PLX group (P = 0.001). There were no significant differences in the incidence rate of lymphedema, lymphocyst and deep vein thrombosis between the PALX and PLX groups (P > 0.05). CONCLUSIONS: Retroperitoneal lymph node dissection is an acceptable operation mode, although slightly increasing the incidence of ileus, compared with the TAH+BSO group. It is needed to choose appropriate indication in order to decrease the post-operative complications.