Screening of asymptomatic postmenopausal women for gynecological malignancies, with special reference to endometrial sampling methods

Abstract

To investigate the applicability of cytological and histological endometrial sampling methods and to study the incidence of silent premalignant or malignant gynecological diseases during the postmenopausal years, 415 asymptomatic women were examined both clinically and with cytological smears and 360 of them also examined with jet wash or pistolet aspiration and Vabra curettage. Examination with jet wash, pistolet aspiration and Vabra curettage was possible in 57.2%, 83.1% and 76.1% of the cases, respectively. The cytological specimens (jet wash, pistolet) and the Vabra curettage specimens were inadequate in 3.7% and 44.5% of cases, respectively. Our study revealed two malignant (one mammary and one gastric cancer with ovarian metastases), seven premalignant (four endometrial and three cervical) and 55 benign gynecological or mammary lesions, amounting to 15.4% of the 415 women. These results, with only four severe endometrial lesions, indicate the restriction of endometrial screening examinations to only well-defined high risk women. Of the methods used, the pistolet aspiration is the most recommendable due to its applicability, patient acceptance, diagnostic reliability and the low incidence of unsatisfactory samples.