Download Diagnostic Techniques for Endometrial Cancer

Diagnostic Techniques
for
Endometrial Cancer
By:Sara Lotfiyan
We don’t have
a standard screening test
for endometrial cancer.
Patients for whom screening
for endometrial cancer is
justified:
1-Postmenopausal women on
exogenous estrogens without
progestins
2-Women from families with HNPCC
3-Premenopausal women with
anovulatory cycles (PCOD)
The ACS did recommended
annual screening for
women with or at risk for
HNPCC.
Abnormal uterine bleeding should
alert the clinician to rule out
corpus cancer, regardless of the
age of the patient:
• Age < 40 & irregular heavy bleeding
• Perimenopausal : Sampling of
endometrium is more important.
• Postmenopausal : Any episode of
bleeding could be Endometrial
Cancer
Techniques Used in the
Diagnosis of Endometrial
Cancer :
1- Definitive technique
2- Cytologic evaluation
3- Traditional four-quarter biopsy
4- Histologic suction devices
5- Endoscopic techniques
6- Imaging techniques
1- Definitive technique
dilatation and
curettage
2- Cytologic evaluation
3- Traditional fourquarter biopsy
4- Histologic suction
devices
5- Endoscopic
techniques
6- Imaging techniques
False Negative of
D&C : 10%
1- Definitive technique
2- Cytologic evaluation
Pap smear
Endometrial
lavage
Endometrial brush
3- Traditional fourquarter biopsy
4- Histologic suction
devices
5- Endoscopic
techniques
6- Imaging techniques
• Only 50% of women
with endometrial cancer
have malignant cells on
a Pap smear.
• Morphologically
abnormal endometrial
cells : 25% (increase
with age)
• Aspiration or scrapping
of endocervical canal :
70 to 85%
1- Definitive technique
2- Cytologic evaluation
Pap smear
Endometrial lavage
Endometrial brush
3- Traditional four-quarter
biopsy
4- Histologic suction devices
5- Endoscopic techniques
6- Imaging techniques
These require :
- special instrumentation
- special cytologic skills
1- Definitive technique
2- Cytologic evaluation
3- Traditional fourquarter biopsy
Novac curet
4- Histologic suction
devices
5- Endoscopic
techniques
6- Imaging techniques
Because of :
• Discomfort associated with
it’s use
• It’s limited sampling of the
cavity
it is no longer used routinly.
1- Definitive technique
2- Cytologic evaluation
3- Traditional four-quarter
biopsy
4- Histologic suction devices
Vabra aspirator
Tis-U-Trap
Pipelle or equivalent
5- Endoscopic techniques
6- Imaging techniques
The choice should be
determined by:
The age of the patient
The experience of the
clinician
Anatomic considerations
The emotional milieu of
the individual patient
• The Pipelle is a soft, flexible endometrial
suction curet
• Use tenaculum for stenotic cervices
Stoval et al. :
The Pipelle had a 97.5% sensitivity in
patients with known endometrial
cancer.
Guido et al. :
The device was less sensitive in
polyps & tumors less than 5% of
endometrial surface
The Pipelle was
• the best device with
detection rate
99.6%
postmenopausal
91%
premenopausal
• sensitive for detection
of endometrial
hyperplasia : 81%
• specific (for all
devices) > 98%
1- Definitive technique
2- Cytologic evaluation
3- Traditional four-quarter
biopsy
4- Histologic suction
devices
5- Endoscopic techniques
Hysteroscopy
Operative hys.
6- Imaging techniques
Iosa et al.
in 2007 outpatient
hysteroscopy
found 22 malignancies
missed 8 ones
In hysteroscopy
The possibility of
PERITONEAL SEEDING
of endometrial cancer with tumor
cells via reflux of the distending
medium through the fallopian tube ?
Obermair & Zebre studies :
Increased risk of possitive peritoneal
cytology in patients who underwent
hysteroscopy.
1- Definitive technique
2- Cytologic evaluation
3- Traditional four-quarter
biopsy
4- Histologic suction
devices
5- Endoscopic techniques
6- Imaging techniques
Ultrasound (vaginal or
abdominal)
Computed
Tomography
Magnetic Resonance
Imaging
In transvaginal ultrasound
Indman et al. :
Sensitivity 96% for abnormal uterine
pathology
Brooks et al. :
• 184 normal endometrial stripe
biopsy
4 atypical hyperplasia
4 endometrial cancer
symptomatic
• 129 thickened endometrial stripe
Only 2 cancers were diagnosed
asymptomatic
In transvaginal ultrasound
• False Negative is 4%
• False Positive is 50%
Endometrial Biopsy is Recommended
when :
• Postmenopausal bleeding &
endometrial stripe thickness >= 5mm
• All women with persistent abnormal
bleeding
Transvaginal sonography + Pipelle
biopsy :
The sensitivity & specificity in the
diagnosis of endometrial carcinoma
reach 100%
Patient acceptability :
Sonography > Hysteroscopy = biopsy