The cellular detection of endometrial carcinoma and its precursors

Abstract

The aim of this presentation is to assess the current expertise and knowledge of the various sampling procedures utilized in the detection of endometrial carcinoma and its precursors. Samples obtained by aspirating the posterior vaginal fornix and cervical canal are readily obtained and inexpensive. However, endometrial cells are infrequently identified, usually limited and deteriorated in samples from the vaginal fornix. In contrast, samples obtained by aspirating the cervical canal usually provides an adequate number of preserved endometrial cells. Samples obtained directly from the endometrial cavity contain a large concentration of cells in an optimal state of preservation, but the technique necessitates sterile conditions and is time consuming, requires more complex instrumentation, and is relatively more expensive. The method of obtaining cell samples from the cervical canal is described. The significance of clinical information in evaluating the presence of endometrial cells is discussed. The cellular features of endometrial carcinoma and its precursors are characterized. Factors influencing accuracy include expertise of the microscopist, cooperation of the physician, histologic grade and type of endometrial carcinoma. With continuing education, the detection rate in samples obtained by aspirating the cervical canal can be improved. The various methods for obtaining cell samples from the endometrial cavity and preparation of the samples are described. Based on current knowledge and expertise, the cell block technique is more suitable for evaluation. Problems relating to the unsatisfactory sample and the detection of precursors of endometrial cancer are discussed. The Gravlee Jet Wash and suction aspiration techniques provide high accuracy for the detection of endometrial carcinoma. However, the detection of the precursors of endometrial cancer by these procedures requires further study.