Thin-Layer Cytology and Histopathology in the Evaluation of Abnormal Uterine Bleeding

OBJECTIVE: To compare thin-layer endometrial cytology to endometrial biopsy and surgical pathology in women with abnormal uterine bleeding. STUDY DESIGN: We performed a prospective study of 103 women. Patients underwent endometrial cytologic evaluation using an endometrial brush, followed by either endometrial biopsy, hysteroscopy with dilation and curettage, or hysterectomy, as clinically indicated. Test performance characteristics and adequacy of cytology and endometrial biopsy were assessed. Ki-67 immunocytochemical expression was evaluated in a random subset of 60 specimens. RESULTS: Cytologic sampling demonstrated a sensitivity of 78%, a specificity of 96%, a positive predictive value of 78% and a negative predictive value of 96% for the detection of endometrial abnormalities. The unsatisfactory rate of uterine cytology was 15% as compared to 26% for endometrial biopsy. Of adenocarcinoma cases, 83% expressed Ki-67, as compared to 30% in benign cases. CONCLUSION: Endometrial cytology may be useful in the detection of endometrial hyperplasia and neoplasia and provides adequate material for the assessment of Ki-67.