Hysteroscopy and Endometrial Cancer Diagnosis: A Review of 2007 Consecutive Examinations in Self-Referred Patients

Abstract

The authors reviewed 2007 consecutive outpatient hysteroscopies performed in self-referred women to assess the detection rate of uterine cancer and the validity of different selection criteria for hysteroscopy. Thirty cases of uterine cancer (29 endometrial, 1 carcinosarcoma) were detected. Abnormal uterine bleeding was the indication most commonly associated with cancer (26 of 30 cases, cancer detection rate = 2.1%), whereas the presence of cervical polyps had no predictive value. Patients age was correlated to cancer detection rate, and the investigation of uterine cancer under the age of 45 was poorly cost effective. Hysteroscopy and endometrial biopsy, performed by Permacurette or Novak curette immediately after hysteroscopy, missed respectively 8 and 2 of 30 cancers. Hysteroscopy should be employed in combination with endometrial biopsy as a standard outpatient investigation whenever endometrial cancer is suspected. These procedures are safe and accurate and rule out more aggressive and costly procedures, such as dilatation and curettage, in most cases.

Postmenopausal Endometrial Pathologies with Tamoxifen Treatment: Comparison between Hysteroscopic and Hysterectomy Findings

“…Two additional cases of carcinoma were diagnosed within 6 months of hysteroscopy/D&C, and both had been missed on both procedures. Of 204 patients with a normal hysteroscopic impression, 23 (11%) had hyperplasia in D&C. Similar results were reported by Lossa et al [36] who performed 2,007 consecutive outpatient hystereoscopies without biopsy, most of which were immediately followed by blind endometrial biopsy. Of 28 cases of carcinoma found on biopsy, hysteroscopy suggested normal endometrium in 2, hyperplasia in 5 and carcinoma in 20.…”

“…This impression may partly be supported by the above mentioned observations, in healthy women, of a relatively high false negative rate in detecting endometrial polyps, endometrial hyperplasia or endometrial carcinoma, by different collection methods of endometrial specimens [34][35][36].…”

Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial cancer: a systematic quantitative review

“…The electronic search generated 1369 citations and of these there were 39 articles 5,12–49 which both reviewers thought were relevant: 37 were published in English, one in French and one in Spanish. A further 13 articles 50–62 were identified through examination of the reference lists of the known primary publications and review articles.…”

Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial hyperplasia

“…The electronic search generated 1369 citations and of these there were 39 articles (15, 17–54) which both reviewers thought were relevant: 37 were published in English, one in French and one in Spanish. A further 13 articles (16, 55–66) were identified through examination of the reference lists of the known primary publications and review articles.…”