Endometrial cytology

Diagnosis of comorbid conditions

To detect pathologies of the cervix and uterine body, a clear screening algorithm is recommended for all patients with premature ovarian insufficiency (POI):

• Cervix: cytological examination of a micropreparation (conventional smear) or liquid-based cytology is indicated.
• Endometrium: if signs of endometrial hyperplasia are detected, aspiration from the uterine cavity must be performed for subsequent cytology. Alternatively, a full pathoanatomical examination of the obtained biopsy material is carried out.

This approach has a recommendation validity level of C and an evidence level of 5.

Rules of material sampling and histological verification

Pathoanatomical (histological) examination of surgical or biopsy material is the definitive method for confirming a gynecological diagnosis.

Interpretation and technique features:

• Sampling of uterine tissues is recommended to be performed under direct visual control using hysteroscopy.
• A positive histology result confirms the clinical diagnosis. However, it is important to understand that a negative result, for example, when searching for lesions, does not rule out the presence of endometriosis.
• In postmenopause, pathoanatomical examination of uterine biopsy or surgical material is mandatory (recommendation level C, evidence level 4).

Differential diagnosis: Histology is the decisive method when evaluating cervical polyps. It allows distinguishing a benign polyp from:

• Adenocarcinoma (invasive or in situ) developing against the background of a polyp.
• Adenomyoma.
• Cervical adenosarcoma.
• Cervical carcinosarcoma.

High oncological alertness: In all cases of deep infiltrative endometriosis and ovarian endometriosis without exception, ovarian biopsy is a mandatory procedure to rule out malignant processes.

Algorithm of actions for pathological cytological findings

Patient management tactics depend directly on the degree of detected cellular atypia. In all listed cases, the algorithm is applied regardless of the patient's HPV status.

1. ASC-H (atypical squamous cells, cannot exclude HSIL):

Colposcopy is indicated, accompanied by a biopsy if necessary.

1. HSIL (high-grade squamous intraepithelial lesion):
2. In patients over 25 years of age: colposcopy is performed in combination with loop electrosurgical excision of the cervical neoplasm or conization.
3. In patients under 25 years of age: colposcopy is performed, supplemented by targeted biopsy or loop excision.

1. AGC (atypical glandular cells):

Colposcopy with possible cervical biopsy is mandatory, as well as fractional diagnostic curettage (FDC) of the cervical canal. Crucially: in women over 35 years of age, endometrial biopsy (uterine body tissues) is strictly added to this algorithm.

Class and exam questions

What else to study on this topic

• Liquid-based cytology: advantages over conventional smear
• Classification of cervical cellular abnormalities (ASC-H, HSIL, AGC)
• Morphological differential diagnosis of adenocarcinoma and adenosarcoma
• Technique of fractional diagnostic curettage (FDC)

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.