Diagnostic accuracy of cytology for the detection of endometrial cancer in urine and vaginal samples

Endometrial cancer is the sixth most common cancer affecting women globally. Most women present early following the onset of postmenopausal bleeding (PMB) and have an excellent prognosis, however for those who present with advanced disease, 5-year survival rates are 15%. PMB triggers urgent investigation by invasive tests that are avoidable for the 90–95% of women who do not have cancer. In this cross-sectional study, the diagnostic accuracy of urine and vaginal cytology for cancer detection in lower urogenital tract samples was tested in 103 women with known cancer and 113 with unexplained postmenopausal bleeding. Urine and vaginal cytology were found to have a combined sensitivity of 91.7% and specificity of 88.8% for gynecological cancer detection. Cytology alone identified 91 endometrial, two fallopian tube and one cervical cancer from 103 known cancer cases. Urine and/or vaginal cytology detected all seven cancers in the unexplained PMB cohort. These results suggest that endometrial cancer can be detected using urine and vaginal fluid. Although further research and validation is needed, these findings provide a promising prospect for primary care based endometrial cancer screening.

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