• John A. Maksem
  • Stanley J. Robboy
  • John W. Bishop
  • Isabelle Meiers
Part of the Essentials in Cytopathology book series (EICP, volume 7)

Direct cytological sampling and examination of the endometrium is not generally practiced, which is surprising as the endometrium is exceedingly easy to sample. Over the years, as we gained more experience with specimen acquisition, processing, and interpretation, we found endometrial cytology to be an effective method both for ensuring endometrial normalcy and for discovering and diagnosing malignant and premalignant states. In comparing endometrial cytology to biopsy, we found that, among samples obtained by individuals experienced in specimen collection, cytology outperforms outpatient biopsy in terms of tolerance of the procedure by the patient, adequacy of the sample among postmenopausal women, and detection of occult neoplasms.

By using the Tao brush (also known as the Indiana University Medical Center endometrial sampler) and devising a technical strategy to ensure the simultaneous creation of cell blocks and cytological samples from a single collection, we moved our appreciation of endometrial brush collection into an arena whose significance equals other methods of specimen collection and interpretation. Cytology performs equally as well as biopsy in detecting hyperplasia and carcinoma. If nothing else, by reliably identifying benign normal endometrial states, it serves to confidently exclude more than 70% of women from unnecessary follow-up testing.

Because the Tao brush samples only the superficial 2 mm of the endometrium, the method is not designed to detect endometrial polyps, leiomyomas, stromal tumors, and tumors of the uterine wall musculature. However, it is useful for detecting benign estrogen-excess states such as disordered proliferation and various degrees of benign hyperplasia and for separating these from neoplastic states such as endometrial intraepithelial neoplasm (EIN), endometrial gland dysplasia (EmGD), and cancer. Nonetheless, it cannot always subclassify benign hyperplastic states of the endometrium without the aid of cell blocks.


Specimen Collection Cell Block Endometrial Polyp Cytological Sample Occult Neoplasm 
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Suggested Reading

  1. Maksem JA, Knesel E. Liquid fixation of endometrial brush cytology ensures a well-preserved, representative cell sample with frequent tissue correlation. Diagn Cytopathol 1996; 14: 367–73.PubMedCrossRefGoogle Scholar
  2. Yang GC, Wan LS, Del Priore G. Factors influencing the detection of uterine cancer by suction curettage and endometrial brushing. J Reprod Med 2002; 47: 1005–10.PubMedGoogle Scholar
  3. Kyroudi A, Paefthimiou M, Symiakaki H, Mentzelopoulou P, Voulgaris Z, Karakitsos P. Increasing diagnostic accuracy with a cell block preparation from thin-layer endometrial cytology: a feasibility study. Acta Cytol 2006; 50: 63–9.PubMedCrossRefGoogle Scholar
  4. Maksem JA, Meiers I, Robboy SJ. A primer of endometrial cytology with histological correlation. Diagn Cytopathol 2007; 35: 817–44.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • John A. Maksem
    • 1
  • Stanley J. Robboy
    • 2
  • John W. Bishop
    • 3
  • Isabelle Meiers
    • 4
  1. 1.Orlando HealthOrlando
  2. 2.Duke University Medical CenterDurham
  3. 3.University of California, DavisSacramento
  4. 4.University Hospital LewishamLondonEngland

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