A Study to Determine the Diagnostic Accuracy of Endometrial aspiration Cytology with Histopathological Correlation at Rural Tertiary Health Care Hospital

  • Siva Kaliyamoorthy Dept. of Pathology, Melmaruvathur Adhiparasakthi Institute of Medical sciences and Research, Melmaruvathur, Tamil Nadu, India
  • Ramya Gandhi Sri Manakula Vinayagar Medical College and Hospital, Kalitheerthalkuppam, Madagadipet, Puducherry, India
Keywords: Abnormal uterine bleeding, Endometrial malignancy, Endometrial aspiration cytology, Dilatation and curettage, Cyclic endometrium, Karman's cannula


Background: Endometrial cytopathology is a powerful tool for the detection of a wide variety of benign lesions,atypias, inflammatory changes and infectious organisms. It is also helpful for the cyto-hormonal evaluation of patients and the detection of endometrial malignancies. Aim:To assess the adequacy of the aspirated endometrial sample and identify the morphological parameters with regard to making a definite diagnosis. The aim of this study is to analyse the accuracy of endometrial aspiration cytology diagnosis in comparison with histopathological correlation. Methods: Endometrial aspiration using a Karman’s cannula was done in 58 patients who presented with abnormal uterine bleeding to the department of Obstetrics and Gynecology during the period of July 2013 to Jan 2015. The cytology smears were stained with Papanicolaou stain and May- Grunwald- Gimesastain. Following aspiration Dilatation and Curettage   was done for all cases. The formalin fixed tissue samples of curettage were stained with Hematoxylin and eosin staining for obtaining the histopathological diagnosis. The statistical analysis was performed using EPI info version 3.5.3. Chi square test was used to correlate the parameters. Result: : In the present study endometrial aspiration cytology and histopathological correlation were performed on 58 cases. The patterns identified on EAC were 27 cases of benign endometrium (46.6%), 24 cases of simple hyperplasia(41.4%)  , 4 cases of endometritis(6.8%),1 atypical hyperplasia (1.7%)  and 2 cases of malignancies (3.4%). Secretory phase endometrium was the most common benign lesion amounting to 36.2% .   Conclusion: Endometrial aspiration cytology was found to be a safe outpatient procedure in the diagnosis of cyclic changes and endometrial lesions.The accuracy of identifying benign, inflammatory and malignant lesions was 98.28% to 100% making EAC an effective procedure.

Author Biography

Ramya Gandhi, Sri Manakula Vinayagar Medical College and Hospital, Kalitheerthalkuppam, Madagadipet, Puducherry, India
Department of Pathology


1. Juan R. Rosai&Ackerman Surgical pathology 10th ed. New Delhi: Elseiver; 2004:p1477-1500.
2 Malik R, Agarwal R, Tandon P. Cytological assessment of endometrial washings obtained
with an insemination cannula and its histological correlation. J Cytol 2008;25:128-32
3. Polson DW, Morse A, Beard RW. An alternative to the diagnostic dilatation and
Curettage - endometrial cytology. Br Med J 1984; 288: 981-983.
4. Hemalatha AN, Pai MR, Raghuveer CV. Endometrial aspiration cytology in dysfunctional
uterine bleeding. Indian J Pathol Microbiol 2006; 49(2):214-217.
5. Dharan M. Utility of cell block preparation in endometrial aspiration cytology: A report of 4 cases. Acta Cytol 2010 Sep-Oct;54(5 Suppl):893-7.
6. Jadhav MV, Phatke AS et al. Endometrial aspiration cytology in gynecological disorders. J Cytol 2016 Jan-Mar;33(1):13-6
7. Simsir A, Carter W, Elgert P, Cangiarella J. Reporting endometrial cells in women 40
years and older. Assessing the clinical usefulness of Bethesda 2001. Am J Clin Pathol.
8. Isaac JH, Ross FH. Cytologic evaluation of endometrium in women with post menopausal
bleeding. Am J Obstet Gynecol 1978;131(4) :410-415.
9. Bistoletti P, Hjerpe A , Mollerstrom G. Cytological diagnosis of endometrial cancer and
pre invasive endometrial lesions. A comparison of the Endo -Pap sampler with fractional
curettage. Acta Obstet Gynecol Scand 1988; 67(4):343-5.
10. Farah MJ, Bhardwaj VK, Evaluation of endometrial aspiration cytology in diagnosis of
normal and abnormal endometrium and its correlation with histopathology. Journal of
Advanced Researches in Biological Sciences 2013; 5(4):366-69.
11. Kaur N, Chahal JS, Bandlish U, Kaul R, Mardi K, Kaur H. Correlation between
cytological and histopathological examination of the endometrium in abnormal uterine
bleeding. J Cytol 2014; 31(3):144-8.
12. Khare A et al. Morphological spectrum of endometrium in patients in patients presenting
with DUB. People’s journal of scientific research. July 2012.5(2):13-16.
13. Koss LG, Melamed MR. Koss diagnostic cytology & its histopathologic basis 5th ed.
Philadelphia: Lippincott Williams & Wilkins; 2005
14. Shu YJ, Ikle FA. In: Cytopathology of the Endometrium-Correlation with
Histopathology. Husain OA, editor. New York: McGraw Hill; 1992. pp. 26–161.
15. Meisels A, Jolicoeur C. Criteria for the cytologic assessment of hyperplasias in
endometrial samples obtained by the Endopap Endometrial Sampler. Acta Cytol 1985;
16. An-Foraker SH, Kawada CY, McKinney D. Endometrial aspiration studies on Isaacs cell
sampler with cytohistologic correlation. Acta Cytol 1979; 23:303–8.

17. Bibbo M et al. Assessment of three sampling techniques to detect endometrial
cancer and its precursors. Acta cytol 1979; 23: 353-359.
18. Morse AR , Ellice RM. Aspiration cytology versus histology in the assessment of
endometrium of women attending a menopause clinic .Br J of Obstet and Gynaecol
19. Arlene J. Uterine Body. In: Color Atlas of normal cytology. Churchill Livingstone 1999;
20.Pacifico E, Miraglia M. Cytologic diagnosis endometrial carcinoma and hyperplasia using
jet washing. Its possible use for and early diagnosis. Gynecol oncol 1988; 11: 44-49.

21. Kyroudi A, Paefthimiou M. Increasing diagnostic accuracy with a cell block preparation
from thin-layer endometrial cytology: A feasibility study. Acta Cytol 2006;50:63–9.
22. Liza S, Ramesh Kumar K, Lillian S. Value of endometrial aspiration cytology in
assessing endometrial status in symptomatic Peri and postmenopausal women. Indian J.
Cancer. Mar 1999; 36(1):57-61.
23. Khare A et al. Morphological spectrum of endometrium in patients presenting with DUB. People’s journal of scientific research July 2012;5(2):13-16.
Original Article