Gynaecological Oncology Research Group, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK.
Manchester Cytology Centre, Manchester University NHS Foundation Trust, Manchester, UK.
Nat Commun. 2021 Feb 11;12(1):952. doi: 10.1038/s41467-021-21257-6.
Postmenopausal bleeding triggers urgent investigation by sequential invasive tests that are avoidable for the 90-95% of women who do not have endometrial cancer. A simple, non-invasive tool that accurately identifies cancer and safely reassures healthy women could transform patient care. Here we report, in a cross-sectional diagnostic accuracy study of 103 women with known cancer and 113 with unexplained postmenopausal bleeding, that urine and vaginal cytology has a combined sensitivity of 91.7% (95% CI 85.0%, 96.1%) and specificity of 88.8% (81.2%, 94.1%) for gynecological cancer detection. Cytology identifies 91 endometrial, two fallopian tube and one cervical cancer from 103 known cancer cases. In women with unexplained postmenopausal bleeding, cytology identifies all four endometrial cancers and three others (cervical, ovarian and bladder), for a 12/107 (11.2%) false positive rate. We show proof-of-principle that endometrial cancer can be detected in urine and vaginal fluid. Prospective validation of these findings will support incorporation of this non-invasive test into clinical practice.
绝经后出血会触发紧急的连续侵入性检查，但对于 90-95%没有子宫内膜癌的女性来说，这些检查是可以避免的。如果有一种简单、非侵入性的工具能够准确识别癌症并安全地让健康女性放心，就可以改变患者的护理方式。在这里，我们在一项对 103 名已知患有癌症的女性和 113 名不明原因绝经后出血的女性进行的横断面诊断准确性研究中报告称，尿液和阴道细胞学检查对妇科癌症检测的联合敏感性为 91.7%（95%CI 85.0%，96.1%），特异性为 88.8%（81.2%，94.1%）。细胞学从 103 例已知癌症病例中识别出 91 例子宫内膜癌、2 例输卵管癌和 1 例宫颈癌。在不明原因绝经后出血的女性中，细胞学检查可识别出所有 4 例子宫内膜癌和另外 3 例（宫颈、卵巢和膀胱），假阳性率为 12/107（11.2%）。我们证明了可以在尿液和阴道液中检测到子宫内膜癌。对这些发现的前瞻性验证将支持将这种非侵入性测试纳入临床实践。
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