Introduction: The efficacy of direct endometrial sampling by brushing in the collection of adequate and representative material is evaluated.
Methods: From January 1 2008 to October 31 2009, 195 women (age 29-82, mean 56, 113 postmenopausal), underwent endometrial brushing with Endoflower. All samplings were performed in an outpatient setting. 137 patients had abnormal uterine bleeding (70 postmenopausal), 25 had asymptomatic endometrial thickening (> 4 mm), 6 had atypical endometrial cells on pap-smear, 9 patients needed preoperative controls for uterine prolapse, 11 were treated with tamoxifen and 7 had other problems. The samples were fixed in a solution containing alcohol, water, EDTA and KCO3, and centrifuged. The supernatant was filtered and the pellet embedded in paraffin.
Results: All patients reported that the technique was painless. Three cases suffered from shock. In 29 cases (15%), the sampling procedure was difficult due to cervical stenosis. A cellular sample large enough to prepare a cell-block was obtained in all cases. In 27 cases (14%), the sample was non-diagnostic. Cases were categorized as non-pathologic (negative) or pathologic (atypical and carcinoma). The correlation between cyto-histology on samples obtained with brushing and histology on biopsy or surgical specimen was possible in 46 cases (24%), with a diagnostic concordance of 93%. The rate of inadequate biopsies was 27% (8/30). 13 of 15 malignant neoplasias (2 carcinosarcomas, 13 endometrioid adenocarcinomas) were correctly diagnosed in samples collected with Endoflower. The sensitivity was 87% and specificity was 96%, with a positive predictive value of 92% and a negative predictive value of 90%.
Conclusions: Endometrial direct sampling with the Endoflower device in an outpatient setting is well tolerated and well accepted by the gynaecologist. This sampling procedure allows preparation of cell-blocks. Endometrial cyto-histology is less expensive and invasive than other procedures and it could therefore be used in association with transvaginal sonography, even in institutions where liquid-based cytology is not in use.