Uterine lavage in the diagnosis of endometrial malignancy and its precursors.

A negative-pressure uterine lavage technique and simple cytologic processing were employed in the detection of endometrial disease in 1,606 patients, 366 of whom were postmenopausal and asymptomatic. Asymptomatic endometrial cancer and its precursors were detected by lavage in patients with negative cervical smear findings, while some symptomatic patients with negative cervical smears and curettage had persistent lavage cytologic abnormalities that preceded histologic confirmation. This technique detected 90.9% of the adenocarcinomas and 59.1% of the atypical/adenocarcinomatous hyperplasias, as compared with 52.3% and 27.3%, respectively, using cervical scraping. Detection rates for endometrial hyperplasia were improved by reporting as abnormal the presence of many clusters of otherwise-normal endometrial cells. In postmenopausal patients, representative endometrial material was obtained in 82.0%, and the procedure was abandoned in 4.1% due to cervical stenosis. Since intrauterine manipulation is unnecessary, the technique was well accepted by elderly asymptomatic women and appears suitable for routine cancer screening.