Hiroki Nakayama

New Terminology for Intrauterine Endometrial Samples: A Group Study by the Japanese Society of Clinical Cytology

Objective: To evaluate the sensitivity and specificity of endometrial cytology obtained by intrauterine sample using a descriptive reporting format for endometrial cytological diagnosis. Study Design: 10,152 consecutive endometrial scrapings obtained in 13 different Japanese hospitals were analyzed. Cytological results were classified as ‘negative for malignancy’, ‘atypical endometrial cells’ (ATEC), ‘endometrial hyperplasia’, ‘atypical endometrial hyperplasia’ or ‘malignant tumor’. ATEC was subclassified as ‘ATEC, of undetermined significance’ (ATEC-US) and ‘ATEC, cannot exclude atypical endometrial hyperplasia or more’ (ATEC-A). Cytological results were compared with the histological diagnosis as a gold standard. When the cytological result was ‘negative for malignancy’ and there was no subsequent histological examination, the case was considered a true negative when the endometrium was assessed as normal on transvaginal ultrasonography and there was no abnormal uterine bleeding. Results: 1,083 cases in which histology was not performed, 557 cases of ‘unsatisfactory specimen’ and 76 cases of ATEC-US were excluded. In the remaining 8,436 cases, the sensitivity and specificity, positive predictive value and negative predictive value for detecting atypical endometrial hyperplasia or malignant tumors were 79.0 and 99.7, 92.9 and 98.9%, respectively. Conclusion: The current diagnostic standards for endometrial cytology in Japan were established. Specificity is satisfactory for excluding cancer or precancerous diseases.

Analysis of stage IVB endometrial carcinoma patients with distant metastasis: a review of prognoses in 55 patients

BackgroundAdequate treatment for extremely advanced endometrial cancer is unknown. The purpose of this study was to clarify the prognosis of patients with stage IVB endometrial carcinoma and the validity of treatment. Furthermore, we evaluated whether there was a connection between the prognosis and the site of metastasis.MethodsThe prognoses of 55 patients with stage IVB endometrial carcinoma were studied with reference to the initial treatment method and the metastatic site at the time of the initial treatment.ResultsThe median survivals of the group of 35 patients who were initially treated with surgery and the group of 10 patients who underwent radiotherapy or chemotherapy as their initial treatment followed by surgery were 11.5 months and 9.5 months, respectively. The residual tumor diameter after surgery was precisely measured in 40 of these 45 patients. The prognosis was significantly better in the patients with a residual tumor diameter of less than 2 cm compared to those with a tumor diameter of 2 cm or greater, and the median survival periods in these two groups were 23.5 months and 11.5 months, respectively (P = 0.027). Furthermore, the prognosis of patients with lung metastasis was significantly better than that of patients with non-lung hematogenous metastasis; the median survival periods of these two groups were 18.5 months and 10.5 months, respectively (P = 0.014).ConclusionFor operable patients, surgery as an initial treatment and reduction of the residual tumor size to less than 2 cm appeared to contribute to a better prognosis. In addition, conservative initial treatment and the presence of non-lung hematogenous metastasis were poor prognostic factors.

Endometrial aspiration cytology for diagnosis of peritoneal lesions in extrauterine malignancies.

OBJECTIVE To evaluate the usefulness of endometrial aspiration cytology for assessing malignant cells of extrauterine origin. STUDY DESIGN Endometrial cytology was performed on 224 patients with primary ovarian cancer, 10 with fallopian tube cancer and 45 with peritoneal tumors. RESULTS Of 224 patients with ovarian cancer, 53 (23.7%) had positive endometrial cytology. Positive rates were: stage I, 4.3%; stage II, 25.0%; stage III, 39.7%; stage IV, 34.5%. Histologic positive rates were: serous, 28.7%; mucinous, 11.4%; clear cell, 23.1%; endometrioid and unclassifiable adenocarcinomas, 28.0%. Of 5 patients with ovarian cancer, 2 were asymptomatic, but aspiration cytology was positive. Of 10 patients with fallopian tube cancer, 9 (90.0%) had positive endometrial cytology. The positive rate on endometrial cytology was 56.7% in stomach cancer, 60.0% in breast cancer and 20.0% in colon cancer. Of 1,209 women with stomach cancer, 30 (2.4%) displayed ovarian metastasis. Of these, 7 (23.3%) had Krukenbergs tumor; endometrial cytology was positive in 1 (14.3%). In 7 of 17 patients with positive endometrial cytology, clinical diagnosis was made before stomach cancer therapy. CONCLUSION Endometrial aspiration cytology is useful for identifying nongynecologic malignant cells, diagnosing ovarian and fallopian tube cancers, and determining peritoneal dissemination and metastasis originating from gastrointestinal and breast cancers.

Clinicopathological study on adenoma malignum of the uterine cervix

目的:子宮頸部悪性腺腫症例の診断の問題点と臨床的取り扱いを検討した.方法:神奈川県立がんセンターで過去に悪性腺腫と診断した症例を津田らが提唱した定義に準じて臨床病理学的に再検討した.成績:過去に悪性腺腫と診断した6例を病理学的に再検討すると, 今回, 定義で悪性腺腫と診断できる症例は1例だけであり, 同時期に取り扱った子宮頸癌の0.1%に相当した. 悪性腺腫を疑った症例では診断的円錐切除術では全病巣が必ずしも評価できていなかった. また, 細胞診所見では一定の傾向を認めることはできなかった.結論:悪性腺腫の診断には診断的円錐切除術の併用が望ましい. その頻度は非常に少ないと思われるので病態の解明には多施設共同研究が望まれる.