Effectiveness of Adding Molecular-Genetic Testing to Liquid-Based Papanicolaou Cytology for Detecting Endometrial Cancer in Women With Comorbidities

BACKGROUND: Developing an effective screening strategy for women with morbid obesity using accessible and simple biological sampling methods remains critical.

AIM: This study aimed to evaluate the effectiveness of additional molecular genetic testing of cervical canal biopsy samples in detecting endometrial cancer in women with morbid obesity.

METHODS: Overall, 378 patients with endometrial cancer were examined. Two groups were formed based on comorbid status: the study group (n = 103) with morbid obesity and comparison group (n = 275) without obesity. The control group included 226 women without oncologic conditions: 47 with morbid obesity and 179 without obesity. Cervical canal samples were collected by brush biopsy. Extracted DNA was amplified using polymerase chain reaction to detect oncogenic mutations in 18 genes.

RESULTS: Oncogenic mutations were identified in endocervical scrapings more frequently in the study group (82.5%; p = 0.042) than in the comparison group (72.4%). In the control group, oncogenic mutations were rare and not significantly associated with obesity (8.5% vs 3.9%; p = 0.193). In patients with endometrial cancer and morbid obesity, mutation detection increased, and the spectrum of mutated genes was broader. The most informative genes for screening were PTEN, TP53, PIK3CA, PIK3R1, CTNNB1, KRAS, FBXW7, FGFR2, APC, and POLE.

CONCLUSION: Molecular testing for oncogenic mutations in cervical liquid-based cytology samples is an effective endometrial cancer screening method. The presence of morbid obesity enhances the test’s diagnostic yield and expands the range of detectable mutations.