The endometrial aspiration smear; research status and clinical value

Abstract

Yu E ARE all aware of the impressive performance of vaginal and cervical smears in t.he diagnosis of early cancer of the cervix ; the high accuracy bids fair to reduce the mortality from this lesion.l-‘b In the detection of adenocarcinoma of the enclometrium, however, vaginal and cervical smears have proved disappointing. Therefore the endometrial aspiration smear has I)een developed, in an attempt. to overcome the intrinsic weaknesses of vaginal smears in endometrial diagnosis. In 1942, Papanicolaou and Jlarchetti’ described the use of this technique in the tliagnosis of c’anc’cr and other conclit.ions of the uterus. Herbut, and RakofY,” in 1951, c*nutionetl against the use of endometrial smears as a routine procedure hecause of the potential dangers in invading the uterine cavity. Bleegman and Speiser” ha\-e reljortecl their utilization of the technique it] gynecological practice. In order to provide a definit.ive evaluation of the endometrial aspiration smear as a diagnostic aid in the detection of endometrinl cancer, a preliminary study of 125 cases was undertaken at Sew York ITfliversity-ISellevue Rledical (‘enter in 1952.1u The results of this work tlemunstratetl the value of the endometrial smear in diagnosing early endolIletl*iill carcinoma. They indicated the potential use of the method in the study of other endometrial abnormalities, and it was shown to he a simple. Ilractical office 1)rocedure in qualified hands. Since t,his work was reported, 4,350 additional cases have heen analyzed. Of these. there were 901 in which the cytologic diagnosis was substantiated by tissue examination. 011 the basis of the analysis of these 901 cases, this paper will attentpt: (1) to clarify the cytology of endometrial cells; (2) to prove the value of endometrinl smears in diagnosing endometrial cancer; (3) to reaffirm the atlvnntages of the technique over vaginal and cervical smears in evaluating rndometrial pathology ; (4) to study furt,her enclometrial nhnornmlities other than canner; (5) to correlate the cytological diagnoses with pathological