Abstract
The aim of this study is to determine the diagnostic cytomorphologic criteria for liquid-based cytology (LBC) with ThinPrep® technique (TP) and to evaluate the reproducibility and usefulness of the cytological diagnosis in endometrial lesions. Furthermore, it was investigated first, the role of LBC with TP technique in the detection of endometrial lesions using direct endometrial sampling with Endogyn device and second, the feasibility of preparing cell-blocks by inverted filter sedimentation (IFS-CB) of endometrial samplings processed by TP. Consequently it was investigated the possibility to increase the diagnostic accuracy of TP endometrial cytology, examining the tissue architecture as an adjunctive method for the detection of endometrial lesions and finally it was determined the DNA ploidy, as an prognostic factor for the endometrial lesions.There were performed 491 endometrial samplings by perimenopausal women who were admitted to «Alexandra» hospital with vaginal bleeding and th ...
The aim of this study is to determine the diagnostic cytomorphologic criteria for liquid-based cytology (LBC) with ThinPrep® technique (TP) and to evaluate the reproducibility and usefulness of the cytological diagnosis in endometrial lesions. Furthermore, it was investigated first, the role of LBC with TP technique in the detection of endometrial lesions using direct endometrial sampling with Endogyn device and second, the feasibility of preparing cell-blocks by inverted filter sedimentation (IFS-CB) of endometrial samplings processed by TP. Consequently it was investigated the possibility to increase the diagnostic accuracy of TP endometrial cytology, examining the tissue architecture as an adjunctive method for the detection of endometrial lesions and finally it was determined the DNA ploidy, as an prognostic factor for the endometrial lesions.There were performed 491 endometrial samplings by perimenopausal women who were admitted to «Alexandra» hospital with vaginal bleeding and thickened endometrium. Then, they were scheduled for diagnostic curettage and hysterectomy. The first 162 endometrial samplings were processed with TP technique and were diagnosed at first, by two skilled cytopathologists for establishing the cytomorphologic diagnostic criteria. Then, three additional cytopathologists without any experience in liquid–based endometrial cytology examined the same cases in order to determine the interobserver variability. The intraobserver variability was also evaluated by all the cytopathologists. The overall interobserver agreement was almost perfect with a k value of 0.89 during the checking round and ranged from moderate to substantial with k values from 0.48 to 0.80 respectively, in the other diagnostic rounds (p<0.0001), with hyperplasia with atypia being the most difficult category to be correctly identified. Furthermore, the intraobserver agreement ranged from substantial to perfect with k values from 0.61 to 1.00, in all diagnostic rounds (p<0.0001) . Dilatation with curettage and hysterectomy were performed to all patients. According to our findings a sensitivity of 98,08%, specificity of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 100% and overall accuracy (OA) of 98,98% were observed in both endometrial sampling and D&C Then, cell block preparation was processed in 263 cases by adequate material of endometrial sampling. The diagnosis with IFS-CB preparation obtained by endometrial sampling, matched that of the hysterectomy specimen. The addition of IFS-CB histology to cytological diagnosis with TP increased the diagnostic accuracy of endometrial cytology to 96.3% and 100% for atrophic endometrium and adenocarcinoma respectively (p=0.39 and p=0.46). Furthermore, in hyperplasia without atypia and hyperplasia with atypia the diagnostic accuracy was increased significantly to 96% and 95.3% respectively (p=0.037 and p<0.001). For DNA ploidy, we used 99 endometrial samplings which were processed by TP and were stained by Feulgen stain. Diverse factors of ploidy were evaluated as DNA index, degree of hyperploidy, ploidy of balance and degree of aneuploidy. These factors were correlated with the final histological diagnosis and there was a statistically significant difference between the neoplasms and the hyperplasia with atypia with the remaining cases. In conclusion: a) liquid-based cytology, using the ThinPrep® technique, allows for unified and reproducible endometrial preparations, which in turn allow the application of common diagnostic criteria among cytopathologists. b) ThinPrep cytology combined with endometrial sampling could be a useful tool for the outpatient diagnosis of endometrial lesions, which could reduce the number of unnecessary curettings.c) Endometrial sampling is complementary to D&C for the diagnosis of endo-metrial lesions and it is necessary to be performed before D&C and/ or hysterectomy.d) TP endometrial cytology provides an accurate cytological diagnosis and the possibility of the IFS-CB preparation from the remaining material, which could be a valuable diagnostic adjunct to the TP cytology and finally e) DNA Ploidy is an important prognostic factor for the endometrial neoplasms, so DNA ploidy is an additional step for selecting patients with better or worth prognosis.
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