Cytological and histological examination of the endometrium based on menstruation age groups

Abstract

Introduction: Abnormal uterine bleeding (AUB) is one of the most common symptoms of endometrial cancer that necessitates endometrial biopsy. Objectives: This study aimed to compare the cytological and histological findings in endometrial specimens among women with AUB in three different menstrual groups (pre-menopause, perimenopause, and post-menopause) and to evaluate the statistical accuracy of cytology compared to histopathology (gold standard). Patients and Methods: This descriptive study was conducted on 78 women with AUB admitted to the gynecology and obstetrics unit of Shahid Beheshti hospital, Isfahan, Iran from 2018 to 2020. Patients were divided into three groups (pre-menopause, perimenopause, and post-menopause) based on their menstrual condition. Samples were obtained using endometrial curettage and cytobrush and were analyzed by two surgical pathologists. The results were described in four categories: negative, atypical endometrial cells of undetermined significance (AEC-US), atypical endometrial cells encompassing the spectrum of precursors to the malignant endometrial tumor (AEC-PEMT), and positive. Results: Out of 78 samples, 36 (46.2%) were reported negative for epithelial abnormality, 15 (19.2%) were AEC-US, 9 (11.5%) were AEC-PEMT, and 18 (23.1%) were positive for epithelial lesions. There was a significant association between cytological findings and menstrual groups (P = 0.004). Positive results were more frequently reported in the post-menopausal group, whereas negative results were most common in the pre-menopause group. The sensitivity and specificity of cytological evaluation in the pre-menopause, perimenopause and post-menopause groups were 100% and 95% (accuracy: 100%, 95% CI: 0.94-1), 77% and 53%, (accuracy: 62%, 95% CI: 0.40-0.85), and 100% and 34% (accuracy: 41%, 95% CI: 0.20-0.61), respectively. Conclusion: Cytological examination of the endometrium demonstrated high sensitivity in the pre-menopausal and post-menopausal women with AUB and can therefore be used as an efficient and valuable method of screening for endometrial neoplasia.