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Screening for endometrial carcinoma.

Histologic techniques have had widespread acceptance for diagnosis of both malignant and premalignant endometrial abnormalities because of their accuracy. In addition most general pathologists are able to accurately interpret endometrial histologic findings. D and C comes close to perfect accuracy but because of cost and the need for local or general anesthesia there are serious drawbacks to its use. Furthermore since the procedure is generally done only on symptomatic patients D and C cannot be considered a true screening technique. Cytologic techniques such as the Issacs cell sampler and the jet wash have also been accurate in diagnosis of cancer but have been less accurate in diagnosis of hyperplastic lessions of the endometrium. Vabra aspiration has many advantages including the ability to obtain good tissue samples and ease of insertion of the small-diameter cannula and gives the most consistent results with both cancerous and precancerous lesions. Unfortunately because of stenosis of the cervix the Vabra aspirator is difficult to use in postmenopausal women the population at greatest risk. Areas of investigation like human chorionic gonadotropin carcinoembryonic antigen and luteinizing hormone levels appear promising as means of identifying those who are at risk for endometrial carcinoma but further developments must be awaited. Whatever technique is used the clinician must be expert in the technical aspect of obtaining the sample and have confidence in the person who interprets it essential to achievement of a high diagnotic accuracy rate and to acceptance of screening for endometrial carcinoma as a part of the routine gynecologic examination in high risk patients.