Direct endometrial brush cytology in detection of premalignant and malignant lesions of endometrium

Abstract

CILJ ISTRAŽIVANJA. Procijeniti dijagnostičku vrijednost direktne endometralne brush citologije u detekciji premalignih i malignih lezija endometrija. USTROJ STUDIJE. Retrospektivno presječno poredbeno istraživanje. ISPITANICI I METODE. Retrospektivnim su istraživanjem obuhvaćene ispitanice u kojih je na Kliničkom zavodu za kliničku citologiju KBC-a Osijek od 2002. do kraja 2015. godine izvršen citološki pregled endometralnog brush razmaza, uz uvjet da su u razdoblju od najduže 6 mjeseci nakon citološke dijagnoze imale i patohistološku verifikaciju. Istraživanjem su obuhvaćene i ispitanice s urednim citološkim nalazom koje nisu imale patohistološku verifikaciju citološkog nalaza, a praćene su najmanje tri godine klinički i ultrazvučno. Isključni kriteriji bili su neadekvatni nalazi. Citološke dijagnoze podijeljene su u četiri kategorije: benigno, hiperplazija, hiperplazija s atipijama te suspektna/maligna lezija. Histološki nalazi učinjeni su na Zavodu za patološku anatomiju i sudsku medicinu KBC-a Osijek. Patohistološka je dijagnoza postavljena na kiretmanu ili resekcijskom materijalu, a u skladu s trenutno važećom WHO klasifikacijom. REZULTATI. Osjetljivost endometralne brush citologije najviša je za benigne lezije s uključenim hiperplazijama i iznosi 90 %. Specifičnost je visoka za sve dijagnoze i kreće se od 87,1 % do 99,3 %. Pozitivna prediktivna vrijednost, izuzetno je visoka za benigne lezije (98,4 %) i maligne lezije (89,5 %), a izuzetno je niska za hiperplazije s atipijama (8,6 %). Ukupna dijagnostička točnost iznosi 91,6 %. ZAKLJUČAK. Endometralna brush citologija pouzdana je dijagnostička metoda za diferenciranje benignih od malignih lezija endometrija, a njezina primjena može umanjiti potrebu za drugim invazivnijim i skupljim dijagnostičkim zahvatima.OBJECTIVES. The goal of this research was to determine the value of the direct endometrial brush cytology in the detection of premalignant and malignant lesions of endometrium. STUDY DESIGN. A retrospective cross-sectional comparative study. PARTICIPANS AND METHODS. The study included subjects who were subjected to the direct endometrial brush cytology at the Department of Clinical Cytology, Clinical Hospital Center Osijek, from 2002 to the end of 2015, provided that they were also subjected to the histological verification, over a period of 6 months after the cytological diagnosis. The study also included subjects with normal cytological findings without histological verification, but with clinical and ultrasound follow-up for at least three years. Exclusion criteria were inadequate specimens. Cytology diagnosis were benign lesions, hyperplasia, hyperplasia with atypias and endometrial carcinoma. Cytology brush samples were fixed in 95% alcohol and stained with Papanicolaou method. Histologic analysis was performed at the Department of Pathology and Forensic Medicine, Clinical Hospital Center Osijek. Histopathological analysis was done on formalin fixed, paraffin embedded samples obtained from fractionated curettage or hysterectomy resection material, according to the current WHO classification. RESULTS. The sensitivity of the uterobrush endometrial cytological examination method for benign lesions and hyperplasia was 90%. The specificity was high in detection of all diagnoses and it ranged from 87.1% to 99.3%. Positive predictive value was high for detecting benign lesions (98.4%) and malignant lesions (89.5%) but low for hyperplasia with atypias (86%). The total diagnostic accuracy of the differential cytology was 91.6%. CONCLUSION. The direct endometrial brush cytology is a reliable diagnostic method for differentiation between benign and malignant lesions and its use can minimize the need for other invasive and more expensive procedures. KEYWORDS. OBJECTIVES. The goal of this research was to determine the value of the direct endometrial brush cytology in the detection of premalignant and malignant lesions of endometrium. STUDY DESIGN. A retrospective cross-sectional comparative study. PARTICIPANS AND METHODS. The study included subjects who were subjected to the direct endometrial brush cytology at the Department of Clinical Cytology, Clinical Hospital Center Osijek, from 2002 to the end of 2015, provided that they were also subjected to the histological verification, over a period of 6 months after the cytological diagnosis. The study also included subjects with normal cytological findings without histological verification, but with clinical and ultrasound follow-up for at least three years. Exclusion criteria were inadequate specimens. Cytology diagnosis were benign lesions, hyperplasia, hyperplasia with atypias and endometrial carcinoma. Cytology brush samples were fixed in 95% alcohol and stained with Papanicolaou method. Histologic analysis was performed at the Department of Pathology and Forensic Medicine, Clinical Hospital Center Osijek. Histopathological analysis was done on formalin fixed, paraffin embedded samples obtained from fractionated curettage or hysterectomy resection material, according to the current WHO classification. RESULTS. The sensitivity of the uterobrush endometrial cytological examination method for benign lesions and hyperplasia was 90%. The specificity was high in detection of all diagnoses and it ranged from 87.1% to 99.3%. Positive predictive value was high for detecting benign lesions (98.4%) and malignant lesions (89.5%) but low for hyperplasia with atypias (86%). The total diagnostic accuracy of the differential cytology was 91.6%. CONCLUSION. The direct endometrial brush cytology is a reliable diagnostic method for differentiation between benign and malignant lesions and its use can minimize the need for other invasive and more expensive procedures