Does hysteroscopy affect prognosis in apparent early-stage endometrial cancer?

Abstract

The objective of the study was to compare the outcome measures of patients with endometrial adenocarcinoma diagnosed by endometrial biopsy, uterine curettage, or hysteroscopy. Medical records of 392 women diagnosed with apparent early-stage endometrial adenocarcinoma were reviewed. Data concerning the mode of diagnosis, histologic type and grade, surgical stage, peritoneal washings and lymph nodes status, and patient's outcome were retrieved. During the study period, 99 (25.3%) cases were diagnosed by endometrial biopsy, 193 (49.2%) by uterine curettage, and 100 (25.5%) by hysteroscopy. There were 347 (88.5%) cases of endometrioid adenocarcinoma and 45 (11.5%) of poor histologic types, including serous papillary, clear cell, and small cell cancer. Three hundred and sixteen (80.6%) patients had stage I disease, 8 (2.0%) stage II, and 68 (17.4%) stage III. Peritoneal cytology was positive in only one case. Recurrent disease occurred in 6.9% patients, of which 50% had local recurrence and 50% had distant. Recurrent disease was found in 15.2% patients diagnosed by endometrial biopsy, in 4.7% where uterine curettage was used, and in 5% when hysteroscopy was applied. No statistically significant difference in the survival rate between the different diagnostic methods applied was found, although a higher recurrence rate was noted following endometrial biopsy. After a median follow-up time of 25 months for patients undergoing hysteroscopy, there was no difference in recurrence rates and/or overall survival compared to other diagnostic procedures implying that hysteroscopy can be safely used in the diagnosis of endometrial cancer.

Investigation of Women with Postmenopausal Uterine Bleeding: Clinical Practice Recommendations

“…Overall, there seems to be a slightly increased risk of positive peritoneal cytologic findings associated with the use of hysteroscopy (OR, 1.78; CI, 1.13-2.79) 95 (Class 1b). However, available high-quality evidence suggests that the prognosis associated with a hysteroscopic diagnosis of endometrial cancer is not different from that with other diagnostic methods 93 (Class 1b), 92,[96][97][98] (Class 3).…”

The role of hysteroscopy in diagnosis and management of endometrial cancer

“…Instead of the act of D&C, it is possible that the disease itself is responsible for the positive peritoneal cytology. The direct relation between positive peritoneal cytology or metastasis and D&C is unclear [4,5,[16][17][18][19][20].…”

“…Endometrial biopsy is not without risk of endometrial cell dissemination. Table 1 shows results of endometrial sampling with Pipelle and subsequent positive peritoneal cytology [4][5][6].…”

Research of an Electronic Endoscope Based on ARM

“…Electronic endoscope image is more clear, bright, vivid, and has higher resolution and signal-to-noise ratio than fiber endoscope. By means of electronic endoscope doctors can find the pathological changes undetected with fiber endoscope, which improves detectable rate of diseases, especially of early stage tumor [5][6][7][8] . One of the most important application fields of electronic endoscope is the early diagnosis of various malignant tumours in womb, including cervical cancer, ovarian cancer, endometrium cancer and so on.…”