Role of Screening Modalities in Endometrial Cancer Detection

  • Angelito Magno
  • Nidhi Arora


Endometrial cancer is the most common gynecological cancer seen in the developed world and is currently on a rise in the developing world as well. The increase in its prevalence is attributable to the rise in the use of exogenous hormones, reproductive factors, and older menopausal age along with obesity. It has an early clinical presentation when the survival rate is good. So, improving the early detection rate can thereby improve the overall survival. In this chapter, we will go through the various screening modalities and more importantly discuss their role in improving the survival rate for this cancer. Also, brief mention is made in the end of the novel techniques that can be used in the near future for screening of the endometrial cancer.


Endometrial cancer Prevalence Screening Endometrial aspiration Endometrial thickness Endometrial cytology 


  1. 1.
    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108.CrossRefGoogle Scholar
  2. 2.
    Howlader N, Noone AM, Krapcho M, Miller D, Bishop K, Altekruse SF, et al. SEER cancer statistics review, 1975–2014. Bethesda: National Cancer Institute; 2017.Google Scholar
  3. 3.
    Lortet-Tieulent J, Ferlay J, Bray F, Jemal A. International patterns and trends in endometrial cancer incidence, 1978–2013. J Natl Cancer Inst. 2018;110(4):354–61. Scholar
  4. 4.
    Jiang X, Tang H. Epidemiology of gynecologic cancers in China. J Gynecol Oncol. 2018;29(1):e7.CrossRefGoogle Scholar
  5. 5.
  6. 6.
    Galczynski K, Nowakowski L, Rechberger T, Semczuk A. Should we be more aware of endometrial cancer in adolescents? Dev Period Med. 2016;20(3):169–73.PubMedGoogle Scholar
  7. 7.
    Practice Bulletin No. 149: Endometrial cancer. Obstet Gynecol. 2015;125(4):1006–1026.Google Scholar
  8. 8.
    Creasman WT, Odicino F, Maisonneuve P, Quinn MA, Beller U, Benedet JL, et al. Carcinoma of the corpus uteri. FIGO 26th annual report on the results of treatment in gynecological cancer. Int J Gynaecol Obstet. 2006;95(suppl 1):S105–43. (Level III)CrossRefGoogle Scholar
  9. 9.
    Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9–29.CrossRefGoogle Scholar
  10. 10.
    Yamagami W, Nagase S, Takahashi F. Clinical statistics of gynecologic cancers in Japan. J Gynecol Oncol. 2017;28(2):e32.CrossRefGoogle Scholar
  11. 11.
    Bokhman JV. Two pathogenetic types of endometrial carcinoma. Gynecol Oncol. 1983;15:10.CrossRefGoogle Scholar
  12. 12.
    Emons G, Beckmann MW, Schmidt D, et al. New WHO classification of endometrial hyperplasias. Geburtshilfe Frauenheilkd. 2015;75:135.CrossRefGoogle Scholar
  13. 13.
    Scully RE, Bonfiglio TA, Kurman RJ, et al. Uterine corpus. In: Histological typing of female genital tract tumours. 2nd ed. New York: Springer; 1994. p. 13.CrossRefGoogle Scholar
  14. 14.
    Kim YB, Ghosh K, Ainbinder S, Berek JS. Diagnostic and therapeutic advances in gynecologic oncology: screening for gynecologic cancer. Cancer Treat Res. 1998;95:253–76.CrossRefGoogle Scholar
  15. 15.
    Zanotti KM, Kennedy AW. Screening for gynecologic cancer. Med Clin North Am. 1999;83(6):1467–87.CrossRefGoogle Scholar
  16. 16.
    Smith RA, von Eschenbach AC, Wender R, Levin B, Byers T, Rothenberger D, et al. American Cancer Society guidelines for the early detection of cancer: update of early detection guidelines for prostate, colorectal, and endometrial cancers. Also: update 2001—testing for early lung cancer detection. CA Cancer J Clin. 2001;51(1):38–75; quiz 7-80CrossRefGoogle Scholar
  17. 17.
    Dillon JL, Gonzalez JL, DeMars L, Bloch KJ, Tafe LJ. Universal screening for Lynch syndrome in endometrial cancers: frequency of germline mutations and identification of patients with Lynch-like syndrome. Hum Pathol. 2017;70:121–8.CrossRefGoogle Scholar
  18. 18.
    Lancaster JM, Powell CB, Chen LM, et al. Society of Gynecologic Oncology statement on risk assessment for inherited gynecologic cancer predispositions. Gynecol Oncol. 2015;136:3.CrossRefGoogle Scholar
  19. 19.
    Tzur T, Kessous R, Weintraub AY. Current strategies in the diagnosis of endometrial cancer. Arch Gynecol Obstet. 2017;296(1):5–14.CrossRefGoogle Scholar
  20. 20.
    Goldstein SR, Nachtigall M, Snyder JR, Nachtigall L. Endometrial assessment by vaginal ultrasonography before endometrial sampling in patients with postmenopausal bleeding. Am J Obstet Gynecol. 1990;163:119.CrossRefGoogle Scholar
  21. 21.
    Karlsson B, Granberg S, Wikland M, Ylöstalo P, Torvid K, Marsal K, et al. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding—a Nordic multicenter study. Am J Obstet Gynecol. 1995;172:1488.CrossRefGoogle Scholar
  22. 22.
    Timmermans A, Opmeer BC, Khan KS, Bachmann LM, Epstein E, Clark TJ, et al. Endometrial thickness measurement for detecting endometrial cancer in women with postmenopausal bleeding: a systematic review and meta-analysis. Obstet Gynecol. 2010;116(1):160–7.CrossRefGoogle Scholar
  23. 23.
    American College of Obstetricians and Gynecologists. ACOG committee opinion no. 440. The role of transvaginal ultrasonography in the evaluation of postmenopausal bleeding. Obstet Gynecol. 2009;114:409.CrossRefGoogle Scholar
  24. 24.
    Goldstein RB, Bree RL, Benson CB, Benacerraf BR, Bloss JD, Carlos R, et al. Evaluation of the woman with postmenopausal bleeding: society of radiologists in ultrasound-sponsored consensus conference statement. J Ultrasound Med. 2001;20:1025.CrossRefGoogle Scholar
  25. 25.
    Yasa C, Dural O, Bastu E, Ugurlucan FG, Nehir A, Iyibozkurt AC. Evaluation of the diagnostic role of transvaginal ultrasound measurements of endometrial thickness to detect endometrial malignancy in asymptomatic postmenopausal women. Arch Gynecol Obstet. 2016;294(2):311–6.CrossRefGoogle Scholar
  26. 26.
    Louie M, Canavan TP, Mansuria S. Threshold for endometrial sampling among postmenopausal patients without vaginal bleeding. Int J Gynaecol Obstet. 2016;132(3):314–7.CrossRefGoogle Scholar
  27. 27.
    Debby A, Malinger G, Glezerman M, Golan A. Intra-uterine fluid collection in postmenopuasal women with cervical stenosis. Maturitas. 2006;55:334.CrossRefGoogle Scholar
  28. 28.
    Schmidt T, Nawroth F, Breidenbach M, Hoopmann M, Mallmann P, Valter MM. Differential indication for histological evaluation of endometrial fluid in postmenopause. Maturitas. 2005;50:177.CrossRefGoogle Scholar
  29. 29.
    Vuento MH, Pirhonen JP, Mäkinen JI, Tyrkkö JE, Laippala PJ, Grönroos M, et al. Endometrial fluid accumulation in asymptomatic postmenopausal women. Ultrasound Obstet Gynecol. 1996;8:37.CrossRefGoogle Scholar
  30. 30.
    Breitkopf DM, Frederickson RA, Snyder RR. Detection of benign endometrial masses by endometrial stripe measurement in premenopausal women. Obstet Gynecol. 2004;104:120.CrossRefGoogle Scholar
  31. 31.
    Goldstein SR, Zeltser I, Horan CK, Snyder JR, Schwartz LB. Ultrasonography-based triage for perimenopausal patients with abnormal uterine bleeding. Am J Obstet Gynecol. 1997;177:102.CrossRefGoogle Scholar
  32. 32.
    Holbert TR. Transvaginal ultrasonographic measurement of endometrial thickness in postmenopausal women receiving estrogen replacement therapy. Am J Obstet Gynecol. 1997;176:1334.CrossRefGoogle Scholar
  33. 33.
    Meuwissen JH, Oddens BJ, Klinkhamer PJ. Endometrial thickness assessed by transvaginal ultrasound insufficiently predicts occurrence of hyperplasia during unopposed oestrogen use. Maturitas. 1996;24:21.CrossRefGoogle Scholar
  34. 34.
    Torres ML, Weaver AL, Kumar S, Uccella S, Famuyide AO, Cliby WA, et al. Risk factors for developing endometrial cancer after benign endometrial sampling. Obstet Gynecol. 2012;120:998.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Kaunitz AM, Masciello A, Ostrowski M, Rovira EZ. Comparison of endometrial biopsy with the endometrial Pipelle and vabra aspirator. J Reprod Med. 1988;33(5):427–31.PubMedGoogle Scholar
  36. 36.
    Wu HH, Harshbarger KE, Berner HW, Elsheikh TM. Endometrial brush biopsy (Tao brush). Histologic diagnosis of 200 cases with complementary cytology: an accurate sampling technique for the detection of endometrial abnormalities. Am J Clin Pathol. 2000;114(3):412–8.CrossRefGoogle Scholar
  37. 37.
    Abdelazim IA, Aboelezz A, Abdulkareem AF. Pipelle endometrial sampling versus conventional dilatation & curettage in patients with abnormal uterine bleeding. J Turk Ger Gynecol Assoc. 2013;14(1):1–5.CrossRefGoogle Scholar
  38. 38.
    Leng X, Wang M, Zhang SL, Wang D, Cao W, Yang XH. Different methods for the diagnosis of endometrial histological comparative study. Zhonghua Fu Chan Ke Za Zhi. 2013;48(12):891–5.PubMedGoogle Scholar
  39. 39.
    Fakhar S, Saeed G, Khan AH, Alam AY. Validity of Pipelle endometrial sampling in patients with abnormal uterine bleeding. Ann Saudi Med. 2008;28(3):188–91.CrossRefGoogle Scholar
  40. 40.
    Machado F, Moreno J, Carazo M, Leon J, Fiol G, Serna R. Accuracy of endometrial biopsy with the Cornier pipelle for diagnosis of endometrial cancer and atypical hyperplasia. Eur J Gynaecol Oncol. 2003;24(3–4):279–81.PubMedGoogle Scholar
  41. 41.
    Zorlu CG, Cobanoglu O, Isik AZ, Kutluay L, Kuscu E. Accuracy of pipelle endometrial sampling in endometrial carcinoma. Gynecol Obstet Investig. 1994;38(4):272–5.CrossRefGoogle Scholar
  42. 42.
    Sanam M, Majid MM. Comparison the diagnostic value of dilatation and curettage versus endometrial biopsy by Pipelle—a clinical trial. Asian Pac J Cancer Prev. 2015;16(12):4971–5.CrossRefGoogle Scholar
  43. 43.
    Rauf R, Shaheen A, Sadia S, Waqar F, Zafar S, Sultana S, et al. Outpatient endometrial biopsy with Pipelle versus diagnostic dilatation and curettage. J Ayub Med Coll Abbottabad. 2014;26(2):145–8.PubMedGoogle Scholar
  44. 44.
    Gungorduk K, Asicioglu O, Ertas IE, Ozdemir IA, Ulker MM, Yildirim G, et al. Comparison of the histopathological diagnoses of preoperative dilatation and curettage and Pipelle biopsy. Eur J Gynaecol Oncol. 2014;35(5):539–43.PubMedGoogle Scholar
  45. 45.
    Kazandi M, Okmen F, Ergenoglu AM, Yeniel AO, Zeybek B, Zekioglu O, et al. Comparison of the success of histopathological diagnosis with dilatation-curettage and Pipelle endometrial sampling. J Obstet Gynaecol. 2012;32(8):790–4.CrossRefGoogle Scholar
  46. 46.
    Guido RS, Kanbour-Shakir A, Rulin MC, Christopherson WA. Pipelle endometrial sampling. Sensitivity in the detection of endometrial cancer. J Reprod Med. 1995;40(8):553–5.PubMedGoogle Scholar
  47. 47.
    Ben-baruch G, Seidman DS, Schiff E, Moran O, Menczer J. Outpatient endometrial sampling with the Pipelle curette. Gynecol Obstet Investig. 1994;37(4):260–2.CrossRefGoogle Scholar
  48. 48.
    Du J, Li Y, Lv S, Wang Q, Sun C, Dong X, He M, Ulain Q, Yuan Y, et al. Endometrial sampling devices for early diagnosis of endometrial lesions. J Cancer Res Clin Oncol. 2016;142:2515–22.CrossRefGoogle Scholar
  49. 49.
    Visser NCM, Reijnen C, Massuger L, Nagtegaal ID, Bulten J, Pijnenborg JMA. Accuracy of endometrial sampling in endometrial carcinoma: a systematic review and meta-analysis. Acta Chir Belg. 2017;130(4):803–13.Google Scholar
  50. 50.
    McCluggage WG. My approach to the interpretation of endometrial biopsies and curettings. J Clin Pathol. 2006;59(8):801–12.CrossRefGoogle Scholar
  51. 51.
    Guidos BJ, Selvaggi SM. Detection of endometrial adenocarcinoma with the ThinPrep Pap test. Diagn Cytopathol. 2000;23:260.CrossRefGoogle Scholar
  52. 52.
    Schorge JO, Hossein Saboorian M, Hynan L, Ashfaq R. ThinPrep detection of cervical and endometrial adenocarcinoma: a retrospective cohort study. Cancer. 2002;96:338.CrossRefGoogle Scholar
  53. 53.
    Lindor NM, Petersen GM, Hadley DW, Kinney AY, Miesfeldt S, Lu KH, et al. Recommendations for the care of individuals with an inherited predisposition to Lynch syndrome: a systematic review. JAMA. 2006;296:1507.CrossRefGoogle Scholar
  54. 54.
    Pilarski R, Stephens JA, Noss R, Fisher JL, Prior TW. Predicting PTEN mutations: an evaluation of Cowden syndrome and Bannayan-Riley-Ruvalcaba syndrome clinical features. J Med Genet. 2011;48:505.CrossRefGoogle Scholar
  55. 55.
    Tan MH, Mester JL, Ngeow J, Rybicki LA, Orloff MS, Eng C. Lifetime cancer risks in individuals with germline PTEN mutations. Clin Cancer Res. 2012;18:400.CrossRefGoogle Scholar
  56. 56.
    Barakat RR, Gilewski TA, Almadrones L, Saigo PE, Venkatraman E, Hudis C, et al. Effect of adjuvant tamoxifen on the endometrium in women with breast cancer: a prospective study using office endometrial biopsy. J Clin Oncol. 2000;18(20):3459–63.CrossRefGoogle Scholar
  57. 57.
    Gerber B, Krause A, Muller H, Reimer T, Kulz T, Makovitzky J, et al. Effects of adjuvant tamoxifen on the endometrium in postmenopausal women with breast cancer: a prospective long-term study using transvaginal ultrasound. J Clin Oncol. 2000;18(20):3464–70.CrossRefGoogle Scholar
  58. 58.
    Yang X, Ma K, Chen R, Zhao J, Wu C, Zhang N, et al. Liquid-based endometrial cytology associated with curettage in the investigation of endometrial carcinoma in a population of 1987 women. Arch Gynecol Obstet. 2017;296(1):99–105.CrossRefGoogle Scholar
  59. 59.
    Wang Y, Li L, Douville C, Cohen JD, Yen TT, Kinde I, Sundfelt K, et al. Evaluation of liquid from the Papanicolaou test and other liquid biopsies for the detection of endometrial and ovarian cancers. Sci Transl Med. 2018;10(433):eaap8793.CrossRefGoogle Scholar
  60. 60.
    Kinde I, Bettegowda C, Wang Y, Wu J, Agrawal N, Shih MI, et al. Evaluation of DNA from the Papanicolaou test to detect ovarian and endometrial cancers. Sci Transl Med. 2013;5:167ra4.CrossRefGoogle Scholar
  61. 61.
    Smith RA, Andrews KS, Brooks D, Fedewa SA, Manassaram-Baptiste D, Saslow D, et al. Cancer screening in the United States, 2017: a review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin. 2017;67(2):100–21.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Angelito Magno
    • 1
  • Nidhi Arora
    • 2
  1. 1.Department of Obstetrics and Gynecology, Section of Gynecologic OncologyDe La Salle Health Sciences Institute, De La Salle University Medical CenterDasmariñas CityPhilippines
  2. 2.Department of Fetal MedicineRainbow HospitalNew DelhiIndia

Personalised recommendations