Endometrial neoplasia--screening the high-risk patient

Increased longevity and use of exogenous estrogens appear to have placed more women at risk of developing endometrial carcinoma. Too infrequently, a diagnosis is made in these women at the premalignant stage of their disease. We assessed cytologically, by means of the Milan-Markley helix technique, 170 women seen at our institutions. These patients were classified in one of the following groups: late menstruators, periclimacteric bleeders, women receiving hormone replacement therapy, and women with endometrial pathologic conditions at the time of curettage. The diagnostic accuracy of the helix technique was assessed. Histologic confirmation was obtained with either Vabra or formal curettage. Tolerance on the part of the patient was excellent. Discomfort sufficient to terminate the procedure occurred in two of 189 samples. There were no complications. Tissue adequate for diagnosis was obtained in 180 of 189 samples. Sensitivity was 97%, specificity was 96%, and predictive value of a positive result was 97%. No cases of adenocarcinoma failed to be detected. We conclude that the Milan-Markley helix technique is safe and dependable in assessing women at risk of developing uterine pathologic conditions.