Tao brush endometrial cytology is a sensitive diagnostic tool for cancer and hyperplasia among women presenting to clinic with abnormal uterine bleeding

• Published in: Cancer medicine (Malden, MA) Vol. 10; no. 20; pp. 7040 - 7047
• Main Authors: DeJong, Stephanie R., Bakkum‐Gamez, Jamie N., Clayton, Amy C., Henry, Michael R., Keeney, Gary L., Zhang, Jun, Kroneman, Trynda N., Laughlin‐Tommaso, Shannon K., Ahlberg, Lisa J., VanOosten, Ann L., Weaver, Amy L., Wentzensen, Nicolas, Kerr, Sarah E.
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.10.2021; John Wiley and Sons Inc; Wiley
• Subjects: Aged; Automation; Biopsy; Biopsy - instrumentation; Biopsy - methods; Bleeding; Cellular biology; Clinical Cancer Researcher; Cytodiagnosis - instrumentation; Cytodiagnosis - methods; Cytology; endometrial biopsy; Endometrial cancer; endometrial cytology; endometrial hyperplasia; Endometrial Neoplasms - complications; Endometrial Neoplasms - pathology; Endometrium; Endometrium - diagnostic imaging; Endometrium - pathology; FDA approval; Female; Histology; Humans; Hyperplasia; Hyperplasia - pathology; Hysterectomy; Malignancy; Middle Aged; Pathology; Patients; Post-menopause; Postmenopause; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity; Statistical analysis; Tao brush; Ultrasonic imaging; Ultrasonography; Uterine cancer; Uterine Hemorrhage - etiology; Uterus; endometrial cancer; endometrial cytology; Tao brush; endometrial hyperplasia; endometrial biopsy
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.4235

Background Abnormal uterine bleeding requires the investigation of the endometrium. Histology is typically used but there remains room for the improvement and use of cytology. Methods Women presenting for clinically indicated office endometrial biopsy were prospectively enrolled. Tao endometrial brushing and office endometrial biopsy were performed, and surgical procedure if clinically indicated. Tao brush cytology specimens were blindly reviewed by up to three pathologists, consensus obtained, and scored as: benign, atypical (favor benign), suspicious, positive for malignancy, or non‐diagnostic. Cytology and histology were compared to surgical pathology to determine sensitivity, specificity, positive, and negative predictive values to detect AH (atypical hyperplasia) or EC (endometrial cancer). Results Clinical indications of 197 enrolled patients included postmenopausal bleeding (90, 45.7%), abnormal uterine bleeding (94, 47.7%), and abnormal endometrium on ultrasound without bleeding (13, 6.6%). Of the 197 patients, 185 (93.9%) had cytology score consensus and a total of 196 (99.5%) had consensus regarding cytology positivity. Surgical pathology diagnoses (N = 85) were 13 (15.3%) FIGO grade 1 or 2 EC, 3 (3.5%) AH, and 69 (81.2%) benign endometrium. Sensitivity and specificity to detect EC or AH were 93.7% and 100%, respectively, via endometrial biopsy; 87.5% and 63.8%, respectively, via endometrial cytology when scores of malignancy, suspicious, or atypical were considered positive. Conclusions In a high‐risk population, Tao brush endometrial cytology showed high sensitivity to detect AH and EC comparable to biopsy histology when considering scores of malignancy, suspicious, atypical, and non‐diagnostic. Revisiting the potential value of endometrial cytology in the contemporary era of endometrial diagnostic workup is warranted. Tao brush cytology is a sensitive tool for endometrial cancer evaluation in symptomatic women. There is a high concordance of Tao brush readings amongst blinded pathologists