diagnostic techniques for endometrial cancer by:sara lotfiyan
TRANSCRIPT
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