Clinical utility of liquid-based cytology for the characterization and management of endometrial polyps in postmenopausal age.

The proper management of endometrial polyps still represents a clinical ongoing challenge, especially when they are asymptomatic and occasionally discovered. The aim of this study was to evaluate liquid-based endometrial cytology to manage endometrial polyps in postmenopausal age by its ability to exclude hidden premalignant and malignant changes within polyps. Three hundred fifty-nine consecutive postmenopausal patients who underwent hysteroscopic diagnosis of endometrial polyp over a 3-year period and who were scheduled for surgical removal within the three subsequent months were retrospectively evaluated. Histologic results after resection during operative hysteroscopy or during hysterectomy were compared with liquid-based cytology and endometrial biopsy obtained at the time of diagnostic hysteroscopy. Eight of 359 patients (2.2%) had malignant or premalignant polyps interpreted as benign finding at hysteroscopy. Unsatisfactory samples were higher for endometrial biopsy compared to liquid-based cytology in the whole series and in the subgroup of low-risk asymptomatic patients (P < 0.001). Endometrial biopsy and liquid-based cytology revealed a sensitivity of 62% and 87.5%, respectively and a 100% specificity. Considering the subgroup of low-risk asymptomatic patients, liquid-based cytology disclosed all the five pathologic lesions with a 100% sensitivity and specificity. In conclusion, liquid-based cytology proved to be a useful tool to establish the nature of endometrial polyps in postmenopausal patients. Complete removal of the lesion should be offered to all symptomatic patients and those with established risk factors for endometrial cancer. Conversely, a wait and see attitude should be considered in case of asymptomatic low-risk polyps with typical appearance on hysteroscopy and negative liquid-based cytology.

[Principles of the clinical evaluation of the vulvar region]. / Principi di valutazione clinica della regione vulvare.

The clinical examination of the vulva, using an articulated method, should form part of the routine gynecological examination thus enabling both the correct diagnosis and treatment of numerous alterations and the prevention and early diagnosis of VIN and invasive neoplasias. A correct evaluation should include basic anamnestic data, a list of symptoms localised in the vulva region, a careful inspection and palpation. The successive aim is to identify the main clinical aspects of the lesion which can be summarized as changes of colour, presence of swellings on surface and loss of substance. The critical evaluation of lesions should allow critical evaluation of lesions should allow the gynecologist to formulate a diagnosis to propose to the pathologist. In this way the collaboration between clinician and pathologist can contribute to progress in the diagnosis and treatment of vulvar diseases.