Detecting Endometrial Cancer by Blood Spectroscopy: A Diagnostic Cross-Sectional Study

Abstract

Endometrial cancer is the sixth most common cancer in women, with a rising incidence worldwide. Current approaches for the diagnosis and screening of endometrial cancer are invasive, expensive or of moderate diagnostic accuracy, limiting their clinical utility. There is a need for cost-effective and minimally invasive approaches to facilitate the early detection and timely management of endometrial cancer. We analysed blood plasma samples in a cross-sectional diagnostic accuracy study of women with endometrial cancer (n = 342), its precursor lesion atypical hyperplasia (n = 68) and healthy controls (n = 242, total n = 652) using attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectroscopy and machine learning algorithms. We show that blood-based infrared spectroscopy has the potential to detect endometrial cancer with 87% sensitivity and 78% specificity. Its accuracy is highest for Type I endometrial cancer, the most common subtype, and for atypical hyperplasia, with sensitivities of 91% and 100%, and specificities of 81% and 88%, respectively. Our large-cohort study shows that a simple blood test could enable the early detection of endometrial cancer of all stages in symptomatic women and provide the basis of a screening tool in high-risk groups. Such a test has the potential not only to differentially diagnose endometrial cancer but also to detect its precursor lesion atypical hyperplasia—the early recognition of which may allow fertility sparing management and cancer prevention.

Metabolomic Biomarkers for Detection, Prognosis and Identifying Recurrence in Endometrial Cancer

“…The downregulation of the lipase enzyme in EC may, in theory, account for the observed findings [71,83]. Using plasma samples from women with EC (n = 342), atypical hyperplasia (n = 68) and healthy controls (n = 242) in a cross-sectional diagnostic accuracy study, our group was able to show that spectroscopy has the potential to detect EC with 87% sensitivity and 78% specificity [84]. In comparison to the controls, EC cases had an increased lipid-related peak (peak at 1446 cm −1 ) and decreased carbohydrate-and fatty acid-related regions (peaks at 1377 and 900 cm −1 ) [84].…”

“…Using plasma samples from women with EC (n = 342), atypical hyperplasia (n = 68) and healthy controls (n = 242) in a cross-sectional diagnostic accuracy study, our group was able to show that spectroscopy has the potential to detect EC with 87% sensitivity and 78% specificity [84]. In comparison to the controls, EC cases had an increased lipid-related peak (peak at 1446 cm −1 ) and decreased carbohydrate-and fatty acid-related regions (peaks at 1377 and 900 cm −1 ) [84]. Its diagnostic accuracy was highest for Type I EC and atypical hyperplasia, with sensitivities of 91% and 100%, and specificities of 81% and 88%, respectively [84].…”

“…Further studies are needed to validate these findings. In an infra-red spectroscopy study by Pareskavaidi and colleagues, amide spectral peaks at 1693 cm −1 and 1547 cm −1 were statistically significantly upregulated in Type II EC compared to Type I, highlighting the potential of blood-based spectroscopy to aid EC stratification [84].…”

“…In comparison to the controls, EC cases had an increased lipid-related peak (peak at 1446 cm −1 ) and decreased carbohydrate- and fatty acid-related regions (peaks at 1377 and 900 cm −1 ) [ 84 ]. Its diagnostic accuracy was highest for Type I EC and atypical hyperplasia, with sensitivities of 91% and 100%, and specificities of 81% and 88%, respectively [ 84 ]. This study was limited by the inability to unpick the exact molecular pathways of identified spectral peaks however, as these peaks can only be tentatively assigned to metabolites because spectral regions may be informed by multiple biological entities [ 84 ].…”

Non-invasive Technology Advances in Cancer—A Review of the Advances in the Liquid Biopsy for Endometrial and Ovarian Cancers

“…benign endometrial pathology in such conditions. For women at population-level endometrial cancer risk, the use of transvaginal sonography with endometrial biopsy as required as a screening tool is limited by a number of factors-including the intimate and invasive nature of the test, high cost, need for specialist sonographers, and the need for different cut-offs based on age and menopausal status (46). These issues have prompted discovery efforts for a non-invasive blood-based biomarker.…”