Research Article: A novel solution configuration on liquid-based endometrial cytology

Date Published: February 5, 2018

Publisher: Public Library of Science

Author(s): Shulan Lv, Rui Wang, Qi Wang, Lu Han, Xiaoqian Tuo, Huilian Hou, Yu Liu, Zan Shi, Qing Wang, Yan Li, Chao Sun, Xue Xue, Qiling Li, Qing Song.


Early detection and diagnosis of endometrial carcinoma and precancerous change would undoubtedly become the most alluring part for researchers. With the emergence of endometrial brush samplers, a new upsurge in endometrial cytology is in the making. But endometrial specimens obtained by the endometrial brush samplers require special preservation solution. The objective of this study is to develop a new kind of endometrial-cell preservation solution and to test the availability compared with a patented liquid-based cell preservation solution.

In this controlled study, we had 5 endometrial cases collected with Li Brush from the First Affiliated Hospital of Xi’an Jiaotong University (09/2016 to 12/2016). The samples of each case were collected 2 times separately and perserved in different perservation solutions. One was a kind of novel endometrial cell preservation solution and the other was a kind of patented liquid-based cell (LBC) preservation solution. The endometrial cells were smeared on slides by using the ZP-C automated slide preparation system and stained with Papanicolaou stain. A semi-quantitative scoring system was used to analyze the quality of slides. Statistical analysis was performed using the Wilcoxon signed rank test on the SPSS program (SPSS 18.0). In all LBC preparations, endometrial cells from the novel endometrial cells preservation solution had more cell quantity, less red blood cell fragments, and the background was cleaner compared with control group. Although the novel endometrial-cell preservation solution showed cellularity and absence of blood and debris expressed by no statistically significant differences (p = 0.063 and 0.102 respectively). The preservation period of the two kinds of liquids was equivalent.

The novel endometrial-cell preservation solution is superior to the liquid-base cell preservation solution for cervical cells, with clear background, diagnostic cells and low cost.

Partial Text

Endometrial carcinoma (EC) is a common malignant tumor of the female genital tract in gynecology. In recent years, the incidence of EC has increased to the fourth most common cancer in women [1]. Early detection and diagnosis of EC and precancerous change would undoubtedly become the most alluring part for researchers. Endometrial biopsy, dilation and curettage (D&C) and hysteroscopy are invasive, painful and expensive. Although transvaginal ultrasound is simple and convenient, it cannot solely be used to rule out malignant endometrial lesions due to poor specificity [2]. Simple, convenient, painless endometrial collectors are used and becoming a screening tool in recent years, such as Li Brush [3], SAP-1[4] and Tao Brush [5], which can collect endometrial cells.

Researchers fail to provide a reliable method for screening of the endometrial lesions partly because that the inappropriate sampling device and the techniques of cell fixation increase the difficulty in obtaining a result interpretation. In 1955, Clyman first reported the endometrial-cells collector named endometrial cannula used in endometrial cytology[17], due to sampling operation is difficult and often suffer from cervical and vaginal cell contamination, therefore, cannot be widely recognized by gynecological pathological physicians. In 1993, LC Tao developed Tao Brush endometrial cell collector which avoids the cell pollution outside uterine cavity and easy to operate, so recognized by the clinical gynecologists and widely used[5]. In some studies, the Tao brush has been reported to be a painless and alternative method for detecting endometrial lesions [18]. Endometrial-cell collector is simple, safe and painless, high quality and low price, which is gradually applied to the cytological screening of endometrial lesions. Li Brush, a self-designed endometrial brush collected endometrial samples, is used in this study. Li-brush is a new type of endometrial brush on the basis of the existing endometrial brush design, combined with the special shape of uterine cavity [3]. The biggest advantage is that you can collect all the cell samples of the uterine cavity, especially the corners and fundus of the uterus.

The novel endometrial-cell preservation solution is superior to the cervical liquid-base cell preservation solution with regard to clear background and cell preservation. If applied in clinic can improve the diagnosis accuracy of endometrial disease, reduce the cost of cell preservation solution. It is worth popularizing and applying.