Yasuo Hirai

Nuclear morphometry as an adjunct to cytopathologic examination of endometrial brushings on LBC samples: A prospective approach to combined evaluation in endometrial neoplasms and look alikes

AbstractObjectiveIn this study, we aimed to retrospectively investigate and confirm whether atypical nuclear findings in endometrial cytology are useful when assessed by image morphometry in liquid‐based cytology (LBC) and compared with microscopic evaluation.MethodsIn total, 53 cases were selected for this study, including 11 presenting proliferative endometrium, 12 with surface papillary syncytial change with endometrial glandular and stromal breakdown (EGBD‐SPSC), 10 endometrioid carcinoma grade 1 (G1‐EEC), 10 EEC grade 3 (G3‐EEC), and 10 endometrial serous carcinomas (ESC). Nuclear image morphometry for nuclear geometric features (area, grey value, aspect ratio, internuclear distance, nucleolar diameter) was performed using ImageJ computer software. For assessing nucleoli, 3861 nuclei were measured, and for nuclear findings, except for nucleoli, 4036 nuclei were measured in total.Results(a) Compared with G1‐EEC, G3‐EEC and ESC presented a marked increase in all six parameters (nuclear enlargement, anisonucleosis, nuclear shade, nuclear shape, irregularity of nuclear arrangement, and nucleolar size). (b) EGBD‐SPSC presented a marked increase in two parameters (nuclear shade, nuclear shape) when compared with G1/G3‐EEC and ESC. (c) Compared with EGBD‐SPSC, EEC and ESC demonstrated a marked increase in nucleolar size (≥2.0 μm). (d) ESC presented a marked increase in nucleolar size (≥3.0 μm) when compared with G3‐EEC.ConclusionsHere we confirmed that atypical nuclear findings evaluated by image morphometry are as useful as microscopic evaluations in endometrial cytology. We believe that the objective evaluation of nucleolar size could contribute to an accurate diagnosis of endometrial‐LBC samples.

A Diagnostic Approach to Endometrial Cytology by Means of Liquid-Based Preparations

The adoption of endometrial cytology as a diagnostic procedure has been hampered in the past by difficulties arising in interpreting the cellular findings due to a number of factors (such as excess blood, cellular overlapping, and the complex physiology of endometrium). Recently, the use of liquid-based cytology (LBC), with its ability to remove blood and mucus and to distribute cells uniformly in a thin layer on the slide, has provided an opportunity to reevaluate the role of endometrial cytology. LBC samples are easier to screen compared to conventional ones, due to a smaller screening area and an excellent quality of cell preparations. LBC by using peculiar cytoarchitectural features is a useful tool in the cellular diagnosis and follow-up of abnormalities, which, however, remains complementary to histopathology and to the emerging molecular diagnostic cytopathology. This review discusses these various entities and takes into consideration the ancillary techniques that may be useful in the diagnostic procedure. Herein, we also summarize the process and rationale by which updates were made to the standardized terminology in 2018 and outline the contents of the new Bethesda-style classification (the Yokohama system) for the endometrial cytology.

Evaluation of Diagnostic Accuracy of Directly Sampled Endometrial Cytology Using ThinPrep for Endometrial Malignancies: Comparison With Existing Endometrial Liquid‐Based Cytology

ABSTRACTObjectiveThe aim of this study was to evaluate the accuracy of detecting malignancies by directly sampled endometrial cytology using globally adopted ThinPrep with a novel preparation technique.MethodsMedical records and reports of pathology and cytology from June 2019 to March 2022 were reviewed. We selected 112 endometrial cytology specimens using ThinPrep with the novel preparation technique, where the clinical course or pathological samples confirmed negative or positive results. Eight cytotechnologists or cytopathologists examined the cytology specimens and provided reports based on standardised criteria from the descriptive reporting system for endometrial cytology (the Yokohama System).ResultsThe 112 specimens were evenly smeared and well prepared, featuring high quality, with no issues hindering microscopic examination. Examiners unfamiliar with endometrial cytology using ThinPrep showed high diagnostic accuracy, demonstrating that this modality of preparation for endometrial cytology is feasible for clinical use.ConclusionsThe novel preparation method using ThinPrep successfully provided high‐quality, standardised specimens. Furthermore, employing the Yokohama System enabled high accuracy in detecting endometrial malignancies, even for examiners with minimal experience with this cytological technique. This suggests that ThinPrep‐based endometrial cytology can be globally adopted with ease, potentially contributing significantly to the early detection of endometrial cancer.