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International Journal of Gynecological Cancer:
doi: 10.1097/IGC.0b013e31829fe8f6
Uterine Cancer

A New Diagnostic Test for Endometrial Cancer?: Cytology Analysis of Sonohysterography Distention Media

Guralp, Onur MD*; Sheridan, Susan M. MD; Harter, Josephine MD; Hinshaw, James Louis MD§; Seo, Songwon MS; Hartenbach, Ellen M. MD; Lindheim, Steven MD#; Stewart, Sarah BS; Kushner, David M. MD

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Abstract

Objective: During saline-infused sonohysterography (SIS), the distension fluid is typically discarded. If cytology analysis could identify those patients with endometrial cancer, many women would be spared from further procedures.

Methods: Thirty consecutive patients with clinical stage I or II endometrial adenocarcinoma were prospectively recruited preoperatively. Saline-infused sonohysterography was performed by instilling 5 mL of saline, withdrawing and sending for analysis. Saline was reinfused until complete SIS images were obtained and sent separately for cytology.

Results: Of the 30 women enrolled, SIS was technically successful in 29. Demographics included mean age (60.5 ± 6.99 years), body mass index (35.55 ± 8.18 kg/m2), endometrioid histology (76%), and grade (grade 1, 67%). Prestudy diagnostic method included biopsy (70%), dilatation and curettage (17%), and hysteroscopy (10%). Adequate cytology specimens were obtained in 66% of the 5 mL flushes and 72% of the complete SIS collections. Of adequate specimens, the sensitivities to detect endometrial cancer for the 5-mL, complete, and combined fluid samples were 26% (95% confidence interval, 9%–51%), 36% (17%–59%), and 42% (22%–63%). Sensitivity based on the whole study sample (N = 30) was 33% (17%–53%). Statistical significance was not found in the association between a positive test and age, body mass index, grade, diagnostic method, or volume instilled or aspirated.

Conclusions: Most patients with early endometrial cancer can undergo SIS procedures with adequate cytology specimens obtained from distention media. However, the sensitivity is low, and refinements are necessary before utilizing as a diagnostic test. In cases with positive results, the patient may be able to avoid other costly and painful procedures.

© 2013 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.

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