Cytomorphological criteria for the differential diagnosis of endometrial hyperplasia and endometrial cancer
Year: 2026
Type: article
Study design: Observational Study
Abstract: Objective of the study: to establish an optimal set of cytological criteria and to develop a mathematical algorithm to improve the effectiveness of the differential diagnosis of endometrial hyperplasia and cancer.Materials and methods. A preoperative examination of the endometrium was carried out in 32 patients with abnormal uterine bleeding by means of aspiration cytology, using a standardized assessment algorithm comprising 7 most informative cytomorphological features. Based on mathematical analysis and Bayes’ theorem, an expert diagnostic system was developed, defining weighting coefficients and threshold values for differentiating between endometrial hyperplasia and endometrial cancer. The cytology findings were verified by the results of the post-operative histological examination.Results. The comprehensive use of standardized cytological criteria in combination with a mathematical algorithm improves the accuracy of the differential diagnosis of hyperplastic and malignant processes of the endometrium. The most significant cytological criteria for differential diagnosis were found to be impaired cell polarity within structures, an increased nuclear-cytoplasmic index, abnormal nuclear and nucleolar shapes, irregular nuclear membranes, neoplastic features and the formation of three-dimensional cell structures. In the group of women aged 30–39 years, a low prevalence of endometrial cancer was confirmed. The summary coefficient did not reach the threshold level. In the 40–49 age group, an increase in the frequency of endometrial hyperplastic processes, polyps and abnormal uterine bleeding was observed. It was in this group that the first case of endometrial carcinoma was recorded. In the patient with a malignant endometrial tumor, the summary diagnostic coefficient significantly exceeded the threshold value (+195), indicating the presence of a complex of cytomorphological features characteristic of malignant transformation of the endometrium. In women aged 60–69 years, endometrial pathology was represented by both glandular hyperplasia and endometrial cancer. The total diagnostic coefficient significantly exceeded the established diagnostic threshold.Conclusions. The results obtained support the comprehensive use of cytological criteria and a mathematical algorithm for differential diagnosis, which helps to improve the accuracy of detecting precancerous and malignant changes in the endometrium and may be recommended for implementation in cytology laboratories and clinical settings.
Source: Reproductive Endocrinology
Institution: Odessa National Medical University
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7203496748