Cytological examination in the diagnosis of precursor lesions and endometrial cancer: single-center, cross-sectional, blind, controlled, non-randomized study

BACKGROUND: Separate diagnostic curettage with material is obtained for histological examination is an invasive procedure with a number of surgical and anesthetic risks. In this regard, the cytological method of endometrial examination, due to the possibility of minimizing the associated risks and the high potential for diagnostic information, is of interest to improve.

AIM: To improve the cytological diagnosis of precancerous diseases and endometrial cancer.

MATERIALS AND METHODS: The study included 136 patients aged 22–79 years with endometrial pathology who underwent examination and treatment in medical institutions in Moscow in the period from 2019 to 2023. All patients underwent surgical treatment in the volume of hysteroscopy with separate diagnostic curettage or hysterectomy, and material from the endometrium was obtained for morphological examination. For cytological examination, the surface of the endometrium or a smear imprint of endometrial tissue were used. For immunocytochemical studies of the expression of p53, PTEN, p63 and CEA markers, 20 samples with endometrial hyperplasia without atypia, 22 samples with endometrioid adenocarcinoma and 5 endometrial samples with atypical hyperplasia were selected. The findings were compared with the results of histological examination and the diagnostic information content of traditional cytology, liquid cytology and their combination was evaluated. Statistical processing of the study results was carried out to generally methods using the StatTech v. 2.6.2 package (Stattech LLC, Russia).

RESULTS: The study revealed a correlation (Pearson chi-squared criterion) between the results of histological examination of the endometrium and liquid cytology, as well as the results of histological examination and traditional cytology (for all indicators p <0.0001). A statistically significant difference in the values of CEA expression in endometrial cells ( p =0.0311) was obtained in the groups of patients with endometrial hyperplasia without atypia, with atypical endometrial hyperplasia and with endometrial adenocarcinoma. The sensitivity and specificity of traditional cytology in detecting endometrial hyperplasia without atypia amounted to 68.4 and 81.7%, liquid cytology — 61.8 and 88.3%, and with the combined use of two cytological methods — 73.7 and 88.3%, respectively. The sensitivity and specificity of traditional and liquid cytology in the detection of atypical endometrial hyperplasia and endometrial adenocarcinoma reached 100 and 97.5%, respectively.

CONCLUSION: The combined use of traditional and liquid cytology expands the possibilities of diagnosing pathological conditions of the endometrium. The significance of the use of the CEA marker in immunocytochemical examination for the diagnosis of endometrial adenocarcinoma has been confirmed.