Diagnostic Value of Cytology in Detecting Endometrial Hyperplasia and Endometrial and Ovarian Cancers in Patients Undergoing Hysterectomy or Salpingo-Oophorectomy

Document Type : Original Article


1 Department of Obstetrics and Gynecology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Department of Parasitology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Ovarian cancer (OC) is one of the most common cancers among women in the world. This study aimed to compare the results of endometrial and endocervical cytology with the ultimate outcome of the uterus, ovary, and fallopian tube (derived from hysterectomy or salpingo-oophorectomy) in diagnosing endometrial hyperplasia, endometrial, and OC. Materials and Methods: This cross-sectional study was conducted on 30 women with endometrial hyperplasia, 90 cases of endometrial cancer, 30 cases of OC, and 30 normal controls undergoing hysterectomy or salpingo-oophorectomy referring to Al-Zahra and Shahid Beheshti Hospitals in 2015–2017. Their basic and clinical characteristics were recorded, and then, endometrial cytology was performed by a specialist and sent to a pathological center. Results: Diagnostic value of cytology showed that out of 90 individuals with endometrial cancer, 78 (86.7%) ones were positive and 12 (13.3%) were negative with sensitivity and specificity of 86.67% and 100%, respectively. Its positive predictive values (PPVs) and negative predictive values (NPVs) were 100% and 71.4% (AUC = 0.933; P < 0.0001). In diagnosing endometrial hyperplasia out of 30 individuals with endometrial hyperplasia, there were 24 (80.0%) positive and 6 (20.0%) negative with sensitivity and specificity of 80.00% and 100%, respectively. Its PPVs and NPVs were 100% and 83.3%, respectively (AUC = 0.9000; P < 0.0001). In diagnosing, OC cytology could not detect any one of the 30 individuals with OC, with sensitivity and specificity of 0% and 100.0%, respectively. Its PPVs and NPVs were 0% and 50%, respectively (AUC = 0.500; P = 1.00). Conclusion: Cytology has a good diagnostic value for detecting endometrial hyperplasia and endometrial cancer compared to pathology; however, due to very low sensitivity in detection of OC, it could not be considered as a good diagnostic tool.


Chambers SK, Hess LM. Ovarian cancer prevention. In: Fundamentals of Cancer Prevention. Switzerland: Springer, Berlin, Heidelberg; 2014. p. 557-91.  Back to cited text no. 1
Olivier RI, Lubsen-Brandsma MA, Verhoef S, van Beurden M. CA125 and transvaginal ultrasound monitoring in high-risk women cannot prevent the diagnosis of advanced ovarian cancer. Gynecol Oncol 2006;100:20-6.  Back to cited text no. 2
Otsuka I, Kameda S, Hoshi K. Early detection of ovarian and fallopian tube cancer by examination of cytological samples from the endometrial cavity. Br J Cancer 2013;109:603-9.  Back to cited text no. 3
Jayson GC, Kohn EC, Kitchener HC, Ledermann JA. Ovarian cancer. Lancet 2014;384:1376-88.  Back to cited text no. 4
Ferenczy A, Gelfand MM. Outpatient endometrial sampling with endocyte: Comparative study of its effectiveness with endometrial biopsy. Obstet Gynecol 1984;63:295-302.  Back to cited text no. 5
Byrne AJ. Endocyte endometrial smears in the cytodiagnosis of endometrial carcinoma. Acta Cytol 1990;34:373-81.  Back to cited text no. 6
Suzuki M, Suzuki T, Matsuura M, Iwasaki M, Tanaka R, Ito E, et al. Prediction of histologic type and lymph node metastasis for advanced ovarian cancer on uterine cervical and endometrial cytology. Acta Cytol 2010;54:575-81.  Back to cited text no. 7
Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, et al. Cancer statistics, 2006. CA Cancer J Clin 2006;56:106-30.  Back to cited text no. 8
Parazzini F, La Vecchia C, Bocciolone L, Franceschi S. The epidemiology of endometrial cancer. Gynecol Oncol 1991;41:1-6.  Back to cited text no. 9
Clarke-Pearson DL. Clinical practice. Screening for ovarian cancer. N Engl J Med 2009;361:170-7.  Back to cited text no. 10
Sundar S, Neal RD, Kehoe S. Diagnosis of ovarian cancer. BMJ 2015;351:h4443.  Back to cited text no. 11
Bedner R, Rzepka-Górska I. Diagnostic hysteroscopy after D and C in women with perimenopausal bleeding. Ginekol Pol 2002;73:577-82.  Back to cited text no. 12
Clark TJ, Mann CH, Shah N, Khan KS, Song F, Gupta JK, et al. Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial hyperplasia. Acta Obstet Gynecol Scand 2001;80:784-93.  Back to cited text no. 13
Mihm LM, Quick VA, Brumfield JA, Connors AF Jr., Finnerty JJ. The accuracy of endometrial biopsy and saline sonohysterography in the determination of the cause of abnormal uterine bleeding. Am J Obstet Gynecol 2002;186:858-60.  Back to cited text no. 14
Symonds I. Ultrasound, hysteroscopy and endometrial biopsy in the investigation of endometrial cancer. Best Pract Res Clin Obstet Gynaecol 2001;15:381-91.  Back to cited text no. 15
Lurain JR. Uterine cancer. In: Berek J, editor. Novak's Gynecology. 13th ed. Philadelphia: Lippincott Williams & Wilkins; 2002. p. 1143-95.  Back to cited text no. 16
Wang W, Guo Y. Value of hysteroscopy and dilatation and curettage in diagnosis of endometrial carcinoma. Zhonghua Fu Chan Ke Za Zhi 2002;37:550-2.  Back to cited text no. 17
Nakagawa-Okamura C, Sato S, Tsuji I, Kuramoto H, Tsubono Y, Aoki D, et al. Effectiveness of mass screening for endometrial cancer. Acta Cytol 2002;46:277-83.  Back to cited text no. 18
Nishimura Y, Watanabe J, Jobo T, Hattori M, Arai T, Kuramoto H, et al. Cytologic scoring of endometrioid adenocarcinoma of the endometrium. Cancer 2005;105:8-12.  Back to cited text no. 19
Huang GS, Gebb JS, Einstein MH, Shahabi S, Novetsky AP, Goldberg GL, et al. Accuracy of preoperative endometrial sampling for the detection of high-grade endometrial tumors. Am J Obstet Gynecol 2007;196:243.e1-5.  Back to cited text no. 20
Okadome M, Saito T, Nishiyama N, Ariyoshi K, Shimamoto K, Shimada T, et al. Prediction of histological types of endometrial cancer by endometrial cytology. J Obstet Gynaecol Res 2014;40:1931-9.  Back to cited text no. 21
Kaur N, Chahal JS, Bandlish U, Kaul R, Mardi K, Kaur H, et al. Correlation between cytological and histopathological examination of the endometrium in abnormal uterine bleeding. J Cytol 2014;31:144-8.  Back to cited text no. 22
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Yanoh K, Norimatsu Y, Hirai Y, Takeshima N, Kamimori A, Nakamura Y, et al. New diagnostic reporting format for endometrial cytology based on cytoarchitectural criteria. Cytopathology 2009;20:388-94.  Back to cited text no. 23