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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

International Journal of Gynecological Cancer: September 2013 - Volume 23 - Issue 7 - p 1252–1257
doi: 10.1097/IGC.0b013e31829fe8f6
Uterine Cancer

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.

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*Bozova Public Hospital, Obstetrics and Gynecology, Sanliurfa, Turkey; †Casper Obstetrical and Gynecological Associates, P. C., Casper, WY; Departments of ‡Pathology, §Radiology, and ∥Biostatistics and Medical Informatics and ¶Division of Gynecologic Oncology, University of Wisconsin School of Medicine and Public Heath, Madison, WI; and #Department of Obstetrics and Gynecology Division of Reproductive Endocrinology and Infertility University of Cincinnati College of Medicine, Cincinnati, OH.

Address correspondence and reprint requests to David M. Kushner, MD, Division of Gynecologic Oncology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, H4-664a, Madison, WI 53792. E-mail:

This study was supported by the ACOG/Kenneth Gottesfeld–Charles Hohler Memorial Foundation Research Award in Ultrasound.

This study was presented at the 60th Annual Clinical Meeting of the American College of Obstetricians and Gynecologists, San Diego, CA, May 2012.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (

Received April 21, 2013

Accepted June 10, 2013

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