Multicenter diagnostic accuracy study of urine and vaginal cytology for endometrial cancer detection in women with postmenopausal bleeding

Postmenopausal bleeding prompts urgent investigation with sequential invasive and costly tests that can be painful and distressing. A simple non-invasive test to identify cancer could transform patient care. The multicenter prospective diagnostic accuracy DETECT study at seven centers in Northwest England evaluated an urine and vaginal cytology for endometrial cancer detection in women with postmenopausal bleeding. Among 1864 participants, 115 (6.2%) had either endometrial cancer (n=99) or other pelvic cancer (n=16). The sensitivity of combined urine and vaginal cytology test for endometrial cancer was 80.8% (95% CI 71.7-88.0) and the specificity was 92.6% (91.2-93.8); for any pelvic cancer, detection sensitivity was 80.8% (71.5-86.9) and specificity was 92.6% (91.2-93.8). The negative predictive value was 98.8% (98.2-99.3) for endometrial cancer detection and 98.6% (97.9-99.1) for any pelvic cancer detection. Of 19 endometrial cancers originally missed by urogential cytology, two (10.5%) had high-grade histology and one (5.3%) was stage 2 or worse, meaning that cytology detected 95.8% of aggressive histologies and 96.4% of locally advanced or metastatic diseases. The authors conclude that the test showed good sensitivity and specificity for endometrial cancer detection.