The Use of Cytology for the Detection of Endometrial Pathologies in Vaginal and Urine Samples in Comparison With Histopathology

Background: Endometrial cancer is the most common gynecological malignancy with increasing incidence. The most common symptom of endometrial cancer is the abnormal uterine bleeding that causes women with this malignancy to be early investigated and treated increasing the rate of successful management because the prognosis of endometrial cancer depends on the stage; it is favorable in those diagnosed at an early stage. Proofing the accuracy of cytology in the screening and diagnosis of endometrial cancer helps to provide a triage method that refers those at high risk for more invasive investigations while avoiding unnecessary interventions in the majority of women who are at low risk. Aim of the study: To evaluate the accuracy of vaginal and urine cytology for the detection of endometrial cancer and other pathologies in comparison with histopathology. Patients & methods: This is a prospective study which enrolled 80 women with postmenopausal bleeding who attended the outpatient clinics of gynecology and oncology in Baghdad Teaching Hospital. Vaginal and urine samples were collected and sent for cytology. Hysteroscopy guided endometrial biopsy was done and the histopathological results were used as standard diagnosis. Results: Both the mean age and BMI were higher in the endometrial cancer group while parity was lower in this group. Diabetes was more prevalent in women with EC. Endometrial thickness was more than five in all women with EC. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of vaginal cytology were 94%, 97%, 88.2%, 98.4%, 31 and 0.06 respectively. All urine samples were negative for malignant cells. Conclusion: This study concluded that vaginal cytology can be used as a simple easy noninvasive method to test those with postmenopausal bleeding, allowing reassurance of the majority of those with PMB while referring those with positive test for invasive investigations. Urine cytology is not useful for the detection of endometrial cancer and other pathologies.