子宮内膜がんスクリーニングの進歩：現在の方法と新興技術の包括的なレビュー

Endometrial cancer represents a major global health concern, with rising incidence particularly in developed countries despite declining mortality rates. This comprehensive review examines the evolution of endometrial cancer screening techniques, encompassing traditional methods, emerging technologies, and integrated approaches. Traditional screening methods including transvaginal ultrasound and hysteroscopy demonstrate varying diagnostic capabilities. Hysteroscopy combined with endometrial biopsy exhibits superior diagnostic accuracy with sensitivity ranging from 62.5 to 100% and specificity from 67.8 to 98.9%. Recent advances in molecular diagnostics show promising potential for non-invasive screening, with DNA methylation analysis achieving sensitivity of 91.8% and specificity of 95.5% when utilizing specific gene panels. Cell-based screening methods including liquid-based cytology and immunocytochemistry provide additional diagnostic pathways, demonstrating sensitivity of 84% and specificity of 98%. Digital image analysis integrated with deep learning technologies enables molecular subtype prediction from histopathological images without requiring expensive sequencing. Combination screening approaches, particularly integrating molecular diagnostics with traditional imaging, demonstrate enhanced diagnostic performance while potentially reducing costs through decreased unnecessary procedures. Molecular testing carries broader implications beyond individual patients, as detection of germline mutations such as Lynch syndrome enables cascade genetic screening benefiting family members through early detection and surveillance programs. While universal screening remains cost-prohibitive for asymptomatic populations, evidence strongly supports personalized screening strategies based on individual risk factors including obesity, diabetes, and hereditary cancer syndromes. Future developments will likely emphasize integrated approaches combining molecular diagnostics with traditional methods to optimize diagnostic accuracy, accessibility, and cost-effectiveness.