OBJECTIVE: To evaluate a new technique for processing endometrial cytology
for the diagnosis and exclusion of endometrial cancer.
STUDY DESIGN: All women at risk for endometrial cancer with clinical indica
tions for endometrial biopsy were evaluated by endometrial brush biopsy (Ta
o Brush, Cook OB-GYN, Bloomington, Indiana) and Pipelle (Cooper Surgical, S
helton, Connecticut) endometrial biopsies during one office visit. Patients
were followed longitudinally for the development of endometrial cancer or
until undergoing dilatation and curettage or hysterectomy. All comparisons
were analyzed using the chi (2) or t test.
RESULTS: One hundred one women (mean age, 58; range, 35-86) had endometrial
biopsies performed. Median follow-up was > 21 months (range, 3-29). Twenty
-two had cancer or atypia, while the remaining had benign diagnoses. When c
orrelated with the final diagnosis, the Tao Brush had 95.5% sensitivity and
the Pipelle, 86% sensitivity. Both devices had 100% specificity, positive
predictive value of 100% and negative predictive value of 98%. When the res
ults of the two biopsy devices are considered together, the positive and ne
gative predictive value for detecting or excluding endometrial cancer was 1
00%. Based on 1998 Medicare reimbursements, a simultaneous second office bi
opsy using the Tao brush could save approximately $67 per case as compared
to a sonohistogram and much more when compared to dilatation and curettage.
CONCLUSION: Endometrial cancer can be reliably detected and excluded using
these two distinct office biopsy devices simultaneously during one office v
isit. In patients with an indication for endometrial biopsy, no further dia
gnostic test may be necessary to exclude or diagnose endometrial cancer or
atypia.