Endometrial Wash Cytology Revisited Utilizing 101 Cases with Subsequent Endometrial Biopsies among Postmenopausal and Perimenopausal Women with Vaginal Bleeding
Victoria L Wilkes, Jason Tsang, Joshy Pathiparampil, Milagros Benedicto, William L Thelmo, Cesar D Del Rosario. Ross Medical School, Roseau, Dominica; Wyckoff Heights Medical Center, Brooklyn, NY
Background: Postmenopausal/perimenopausal vaginal bleeding requires full evaluation of the endometrium including vaginal ultrasonography and pathological evaluation. Endometrial biopsy is commonly performed to exclude cancer and endometrial hyperplasia. However, the positive yield of endometrial biopsies is less than 100% because the abnormal endometrium may be focal, occupying less than 5% of the surface area of the endometrial cavity or less than 25% of the area in those confined to the endometrial polyp. The use of endometrial wash examination may add valuable pathological information since cells from different parts of the uterine cavity are sampled.
Design: To evaluate whether saline endometrial wash will yield additional valuable pathological findings a total of 101 cases of endometrial saline wash followed by endometrial biopsy among women (52 to 72 years old) with vaginal bleeding was reviewed.
Results: Of the 101 cases, ninety showed negative findings (negative for glandular atypia/dysplasia or carcinoma) in both endometrial wash and endometrial biopsy. There were eleven cases (10.9%) of endometrial wash with positive findings (presence of either glandular atypia/dysplasia or carcinoma). There were six cases diagnosed with adenocarcinoma in both endometrial wash and endometrial biopsy. Five of these cases underwent hysterectomy in our hospital and the hysterectomy specimens also showed adenocarcinoma. One case transferred to another institution and no follow-up information is available. There were five cases diagnosed with atypical glandular cells. The endometrial biopsies of these five cases showed: a.) one well differentiated adenocarcinoma, b.) two glandular atypia, c.) one endometrial hyperplasia with atypia, and d.) one negative. The last case with a negative biopsy finding, repeat endometrial wash and biopsy were performed. The repeat endometrial wash revealed adenocarcinoma, however, the endometrial biopsy was negative. The patient transfered to another institution were an endometrial biopsy was also performed which showed no evidence of malignancy. Following a review of our endometrial wash cytology material the patient underwent hysterectomy. The hysterectomy specimen revealed multiple endometrial polyps with in situ high grade serous carcinoma.
Conclusions: Our data therefore, although limited, showed that endometrial wash in addition to endometrial biopsy may offer valuable pathologic information in the work-up of women with perimenopausal and postmenopausal bleeding.
Tuesday, March 20, 2012 9:30 AM
Poster Session III # 48, Tuesday Morning