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  • Title: Endometrial brush biopsy. An accurate outpatient method of detecting endometrial malignancy.
    Author: Wu HH, Casto BD, Elsheikh TM.
    Journal: J Reprod Med; 2003 Jan; 48(1):41-5. PubMed ID: 12611094.
    Abstract:
    OBJECTIVE: To describe 633 cases using the Tao Brush for endometrial biopsy (EBB) in an outpatient setting. STUDY DESIGN: Histologic follow-up specimens within six months of EBB in an outpatient setting were evaluated over a two-year period. Diagnosis by EBB relied mainly on histologic evaluation of hematoxylin and eosin-stained tissue sections and was complemented by additional cytologic smear examination in our laboratory. Diagnostic categories included the following: nondiagnostic (ND), benign endometrium (BE), hyperplasia without atypia (H), atypia (AT) and atypical hyperplasia (AH)/carcinoma (CA). The correlation between EBB and follow-up histology was analyzed. RESULTS: A total of 633 EBBs were evaluated. Diagnoses were rendered in 569 cases, with a diagnostic rate of 90%. Histologic follow-up was evailable for 156 patients. Twelve AH/CA diagnosed by EBB were confirmed by histologic follow-up as CA. However, there was one false positive case, in which EBB showed AH/CA and dilatation and curettage (D&C) revealed disordered, weakly proliferative endometrium. Nine of 10 EBBs with AT diagnoses were 3 CA, 1 AH and 5 BE on follow-up. Two of eight H had D&C follow-up that also showed H. Histologic follow-up was available in 114 of 538 benign EBBs and showed benign correlation in 112 cases. There were two false negative cases; the EBB diagnoses were atrophic endometrium and weakly proliferative endometrium, while D&C showed focal AH in both cases. Among the ND cases, 18 of 64 had tissue follow-up and disclosed 4 CA, 1 H, 12 BE and 1 ND. CONCLUSION: EBB is a reliable diagnostic tool for endometrial sampling in an outpatient setting. The sensitivity and specificity in identifying CA among satisfactory specimens is 100% and 96%, respectively, when AT or a more severe diagnosis is made by EBB. Assessment of specimen adequacy is important for pathologists interpreting EBB. In our study, four cases of adenocarcinoma were identified in the follow-up D&C in patients with nondiagnostic EBB.
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