Diagnostic Techniques Diagnostic Techniques for for

Endometrial CancerEndometrial Cancer

By:Sara LotfiyanBy: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 HNPCC3-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 technique2- Cytologic evaluation3- Traditional four-quarter biopsy4- Histologic suction devices5- Endoscopic techniques6- Imaging techniques

1- Definitive technique dilatation and curettage2- Cytologic evaluation3- Traditional four-

quarter biopsy4- Histologic suction

devices5- Endoscopic

techniques6- Imaging techniques

False Negative ofD&C : 10%

1- Definitive technique2- Cytologic evaluation Pap smear Endometrial

lavage Endometrial brush3- Traditional four-

quarter biopsy4- Histologic suction

devices5- 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 technique2- Cytologic evaluation Pap smear Endometrial lavage Endometrial brush3- Traditional four-quarter

biopsy4- Histologic suction

devices5- Endoscopic techniques6- Imaging techniques

These require :

- special instrumentation

- special cytologic skills

1- Definitive technique2- Cytologic evaluation3- Traditional four-

quarter biopsy Novac curet4- Histologic suction

devices5- Endoscopic

techniques6- 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 technique2- Cytologic evaluation3- Traditional four-quarter

biopsy4- Histologic suction

devices Vabra aspirator Tis-U-Trap Pipelle or equivalent5- Endoscopic techniques6- Imaging techniques

The choice should be determined by:The age of the patientThe experience of the clinicianAnatomic 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 technique2- Cytologic evaluation3- Traditional four-quarter

biopsy4- Histologic suction

devices5- 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 technique2- Cytologic evaluation3- Traditional four-quarter

biopsy4- Histologic suction devices5- Endoscopic techniques6- Imaging techniques Ultrasound (vaginal

or

abdominal) Computed

Tomography Magnetic Resonance Imaging

In transvaginal ultrasound

Indman et al. :Sensitivity 96% for abnormal uterine

pathologyBrooks et al. :• 184 normal endometrial stripe biopsy4 atypical hyperplasia4 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