Supplementary Material for: Influence of Estradiol-Producing Ovarian Tumors on the Maturation Index of Cervical Cytology in Postmenopausal Women

<b><i>Introduction:</i></b> The aim of the study was to evaluate the influence of estradiol-producing ovarian tumors, including surface epithelial-stromal tumors, on the cervical cytology of postmenopausal women. <b><i>Methods:</i></b> This case-controlled study included 160 postmenopausal women who underwent a gynecological surgery between January 2009 and December 2016. The relationship between serum estradiol levels and the maturation index of cervical cytology was examined. Patients with ovarian tumors and a high estradiol level (≥28 pg/mL) constituted the estradiol-producing ovarian tumor group (30 women, including 23 with surface epithelial-stromal tumors). The maturation index of this group was compared with that of the control group (130 women with normal estradiol levels [&lt;28 pg/mL] with either ovarian tumors or uterine tumors). <b><i>Results:</i></b> For all patients, the serum estradiol levels were significantly correlated with the maturation index (<i>p</i> &lt; 0.001, <i>r</i> = 0.65). The maturation index of the estradiol-producing ovarian tumor group was significantly higher than that of the control group (0.67 ± 0.21 vs. 0.075 ± 0.16, <i>p</i> &lt; 0.001). The area under the receiver operating characteristic curve for the maturation index was 0.94. The best maturation index cut-off level for estradiol-producing ovarian tumors was 0.20. Using this cut-off, the sensitivity and specificity were 94% and 82%, respectively. <b><i>Conclusion:</i></b> Estradiol-producing ovarian tumors influence cervical epithelial maturation in postmenopausal women. An increased maturation index may trigger the early detection of asymptomatic ovarian tumors.<b><i>引言:</i></b> 本研究旨在评估分泌雌二醇的卵巢肿瘤（含表面上皮间质肿瘤（surface epithelial-stromal tumors））对绝经后女性宫颈细胞学的影响。<b><i>方法:</i></b> 本项病例对照研究纳入了2009年1月至2016年12月间接受妇科手术的160名绝经后女性。研究分析了血清雌二醇水平与宫颈细胞学成熟指数的相关性。将患有卵巢肿瘤且血清雌二醇水平较高（≥28 pg/mL）的患者划为分泌雌二醇卵巢肿瘤组（共30例，其中23例为表面上皮间质肿瘤），并将该组的宫颈细胞学成熟指数与对照组（共130例，血清雌二醇水平正常[<28 pg/mL]，且患有卵巢肿瘤或子宫肿瘤）进行对比。<b><i>结果:</i></b> 所有受试者的血清雌二醇水平与宫颈细胞学成熟指数均呈显著相关（p < 0.001, r = 0.65）。分泌雌二醇卵巢肿瘤组的成熟指数显著高于对照组（0.67 ± 0.21 vs. 0.075 ± 0.16, p < 0.001）。宫颈细胞学成熟指数的受试者工作特征曲线（receiver operating characteristic curve）下面积为0.94。诊断分泌雌二醇卵巢肿瘤的最佳成熟指数截断值为0.20，以此为阈值时，检测灵敏度为94%，特异度为82%。<b><i>结论:</i></b> 分泌雌二醇的卵巢肿瘤可影响绝经后女性的宫颈上皮成熟状态。宫颈细胞学成熟指数升高可辅助早期发现无症状卵巢肿瘤。