Reliability of oupatient endometrial brush cytology vs biopsy in postmenopausal symptomatic women

Objective To compare outpatient endometrial sampling cytology with conventional biopsy in postmenopausal women with abnormal uterine bleeding and/or abnormal endometrial thickness at ultrasound Method Between December 2003 and December 2009 a group of 1 056 postmenopausal women was referred to the Department of Gynecological Sciences Perinatology an Child Health 11 Faculty of Medicine University of Rome S Andrea Hospital Four hundred and eighty two patients (45 6%) had abnormal uterine bleeding and 602 (57 0%) showed an endometrial thickness > 5 mm at ultrasound Patients on hormonal therapy (n = 194) including hormonal replacement therapy (HRT) or tamoxifen (TMX) were enrolled in the study Endometrial cytologic sampling was per formed using a brush device (EBC) while endometrial histological sampling was retrieved using a Novak curette Histologic evaluation showed a) malignant neoplasia b) atypical hyperplasia c) benign pathology d) normal or atrophic endometrium The following points were investigated a) failure in performing a procedure for cervical stenosis or pelvic pain b) nondiagnostic specimens c) diagnostic accuracy Results Evidence in score pain differences between brush and curette endometrial samples were observed 50% of patients undergoing brush cytology had lower pain scores (chi square = 288 33 p = 001) whereas 60% of patients undergoing endometrial biopsy had higher pain scores (chi square = 264 84 p = 001) The failure rate in performing procedures was 8 0% vs 4 1% and the results were statistically significant on the McNemar test respectively p = 01 and p = 001 A nondiagnostic specimen was obtained in 3 9% of cases by EBC and 103% of cases by the Novak curette (p = 001) Cytological evaluation had a sensitivity of 100% specificity of 99% positive and negative predictive value of 97% and 100% for diagnosing malignant neoplasia Cytology had high diagnostic accuracy for atypical hyperplasia sensitivity 100% specificity 99% positive and negative predictive value 83% and 100% respectively Conclusions EBC is a reliable well tolerated outpatient diagnostic tool for endometrial sampling in detecting early stage cancer in postmenopausal patients at high risk for endometrial cancer