Fallopian Tube Cytology for Exploratory Detection of Adnexal Malignancy: Prospective Evaluation of the CytoSaLPs Score in an Ex Vivo Surgical Cohort

Objective: Ovarian, fallopian tube, and primary peritoneal cancers are the deadliest gynecological malignancies, largely due to delayed diagnosis, tumor heterogeneity, and lack of effective methods for early detection. Increasing evidence suggests that most high-grade serous ovarian carcinomas originate from the fallopian tube epithelium. Consequently, recent studies have focused on fallopian tube cytology and its correlation with histological findings. We aimed to evaluate the exploratory diagnostic performance of ex vivo fallopian tube cytology and the CytoSaLPs score for detecting adnexal malignancies in women undergoing salpingectomy. Methods: We conducted a prospective observational study including 304 women undergoing salpingectomy or salpingo-oophorectomy for benign or malignant gynecological indications between 2020 and 2023. Ex vivo cytological brushing of the fimbrial end was performed before fixation. The primary endpoint was diagnostic accuracy compared with histology. Secondary endpoints included evaluation of the CytoSaLPs score using receiver operating characteristic analysis. Results: 491 speciments were obtained. Cytological findings were correlated with histology, demonstrating the diagnostic value of tubal cytology. For fallopian tubes, cytology showed a sensitivity of 94.4%, specificity of 71.0%. and accuracy of 72.7%. Ovarian cytology showed lower sensitivity (72.9%) and specificity (70.7%). For the adnexa as a single entity, sensitivity was 76.5% and specificity 70.7%. ROC analysis demonstrated strong performance of the CytoSaLPs Score for fallopian tubes (AUC 82.9%), moderate performance for ovaries (AUC 63.4%), and fair performance for adnexa overall (AUC 69.9%). Conclusion: This exploratory proof-of-concept study suggests that ex vivo fallopian tube cytology combined with the CytoSaLPs score may represent a promising adjunctive approach for future early detection strategies. External validation is required before clinical implementation.