Performance characteristics of the Indiana University medical center endometrial sampler (Tao brush) in an outpatient office setting, first year's outcomes: Recognizing histological patterns in cytology preparations of endometrial brushings

Following successful hysterectomy-controlled trials, Tao brush endometrial cytology with liquid fixation was offered to clinicians for office use. thi s report recounts our first year's cytology and correlative histology outco mes. One hundred thirteen cases were accrued. Correlative tissue examinatio ns comprising Pipelle (Prodimed, Neuilluy-en-Thelle, France) biopsy, hyster oscopy and biopsy, dilation and curettage, and hysterectomy were available at this institution for 59 cases. In 42 cases, cytology diagnoses could be compared to histology diagnoses. Twenty-five of 63 normal brushings were fo llowed up. Fourteen were normal. Eleven Pipelle biopsies of cytologically a trophic endometrium were quantitatively limited and insufficient for diagno sis. Thirty-seven cases were abnormal, and 15 of these showed nuclear anapl asia. Twenty-eight of the abnormal cases were followed up. All correlative tissue examinations confirmed an abnormality. All 15 cases with nuclear ana plasia showed significant histopathology comprising atypical endometrial hy perplasia, endometrial intraepithelial neoplasia (EIN), endometrial intraep ithelial carcinoma (EIC), and invasive adenocarcinoma. There were 13 inadeq uate endometrial brushings. Three cases had insufficient cellular material. The remaining 10 cases were cellular but were chiefly cervical/endocervica l samples. Two of the cellular cases resulted from clinicians failing to re place the protective sheath over the brush bristles before removing the Tao brush from the endometrial cavity. The remaining 11 cases resulted rom ina ccessibility of the uterine cavity due to a tight or stenotic cervix. The T ao brush is a reliable uterine sampling device that performs well as a diag nostic tool for outpatient assessment of the endometrium of women with pate nt cervices. An advantage of endometrial cytology is that it accurately rep resents atrophic endometrium, and it is an effective case-finding tool for EIN and EIC, Women with tight of stenotic cervices are poor candidates for endometrial brushing, and may experience pain if the procedure is attempted . Diagn. Cytopathol. 2000;22:186-195. (C) 2000 Wiley-Liss, Inc.