Early detection of ovarian and fallopian tube cancer by examination of cytological samples from the endometrial cavity

Abstract

Background:Accumulating evidence suggests that many ovarian high-grade serous carcinomas (HGSCs) originate in the fallopian tube. Malignant cells shed by tubal lesions can be detected by examination of cytological samples from the endometrial cavity (endometrial cytological testing). To evaluate the use of this method for detecting HGSC, we examined epithelial ovarian, fallopian tube, and primary peritoneal cancer patients.Methods:Endometrial cytological testing was performed for endometrial cancer screening in asymptomatic women and for pre-treatment evaluation in symptomatic suspected ovarian, tubal, and peritoneal cancer patients.Results:Of the 122 ovarian, tubal, and peritoneal cancer patients, malignant cells were identified in 5 patients who did not show detectable abnormalities on imaging studies. Cervicovaginal cytology was positive in only one of these five patients. Four patients were asymptomatic and one was symptomatic. Three asymptomatic patients had early-stage HGSCs, and the other asymptomatic patient had positive peritoneal cytology findings but no detectable tumour. HGSC patients were significantly more likely to have positive findings on endometrial cytology than patients with other histological types (23% vs 6%, P=0.02).Conclusion:Endometrial cytological testing can detect early-stage ovarian, tubal, and peritoneal HGSCs without detectable pelvic masses and may be useful for ovarian cancer screening.

Does histopathological examination still have value in detecting and preventing cancer?

“…However, the character of the whole structure of the specimen, followed by the visual examined is the principal step used by pathologists in the diagnosis of the abnormal tissue 1 . In addition, the cytological examination has also played an important role in the diagnosis of cancer 4 , and its results could be helpful for confirming of the histological examination 13,22 . Although the cytological analysis has many disadvantages [23][24] , it also has several benefits compared with the pathological analysis, including cost-effectiveness, rapid turnaround time, providing a minimal risk for the patient, and giving the results when other techniques failed 1,4 .…”

“…The first one is the accuracy in detection of cancer compared with that obtained with other methods 4,[6][7]10 and the ability to differentiate between benign and malignant disease 18,25 . Furthermore, the assistance of other methods for detection of cancer is another benefit of histopathological examination as it increases the sensitivity of PSA in the detection of the prostate cancer 26 or preliminary diagnosis of basal cell carcinoma based on the appearance 20 .…”

“…However, the accuracy of cancer diagnosis by a pathologist will give a good recommendation to the physician for making the right decision about suitable treatment. Furthermore, for diagnosis of many cancers, a histopathological examination is obligatory for confirmation, even when other diagnostic methods have failed to discover such types of malignant disease as breast cancer, oral squamous cell carcinoma and many of female genital tract cancers [4][5][6][7] . Thus, the histopathological examination should be given a full priority by the surgical and clinician teams for detection of cancer.…”

Ovarian cancer: screening and future directions

“…A study involving 122 suspected cancer patients found five patients with positive endometrial cytologic results displaying early neoplastic change. In another study, Otsuka et al showed that patients with high-grade serous ovarian carcinomas were significantly more likely to have positive endometrial cytology compared with other histological subtypes (23% vs 6%, p=0.02) 34. Alternatively, molecular cancer signatures have also been picked up in uterine lavage fluid.…”

Refractory fallopian tube carcinoma – current perspectives in pathogenesis and management

“…The early detection of an STIC can help in the prevention of invasive ovarian cancers; however, no screening techniques are currently available to detect STIC. Endometrial cytological testing may detect early-stage ovarian, tubal, and peritoneal HGSCs and may be useful for ovarian cancer screening, but this study needs further validation 82. The inclusion of patients with FTC, PPC, and HGSC of the ovary in clinical trials is recommended as they have similar molecular abnormalities and likely the same cell of origin.…”