Impact of hysteroscopy on disease-free survival in clinically stage I endometrial cancer patients

Abstract

Recent data strongly suggest tumor cell dissemination of endometrial carcinoma cells in the course of fluid hysteroscopy. In patients who had endometrial cancer which was (except for peritoneal cytology) confined to the uterus, the disease-free survival (DFS) of 135 patients who underwent hysteroscopy prior to staging laparotomy was compared with the DFS of 127 patients without hysteroscopy. After a median follow-up of 23 months, 10 patients experienced tumor recurrence. Although there was a trend towards a higher incidence of positive peritoneal cytology at laparotomy in patients who underwent hysteroscopy, this difference did not achieve statistical significance (P = 0.47). For 5 years, the DFS was 92.4% in patients with hysteroscopy and 84.7% in patients without hysteroscopy before laparotomy (log-rank, P = 0.782). Our data therefore suggest a similar short-term DFS in endometrial cancer patients with and without hysteroscopy prior to laparotomy.

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).…”

Diagnosis of endometrial cancer by hysteroscopy does not increase the risk for microscopic extrauterine spread in early-stage disease

“…Conversely, Selvaggi et al [18] did not find that fluid hysteroscopy increased the risk of microscopic intraperitoneal spread in 147 patients with endometrial cancer when comparing hysteroscopy to D&C as the diagnostic procedure. In their report on 113 patients with endometrial carcinoma, Obermair et al [19] found that positive peritoneal cytology was associated with a history of hysteroscopy, but they did not show any significant differences in short-term disease-free survival that could be related to the diagnostic procedure [20]. Finally, Zerbe et al [21] reported a statistical difference in the frequency of positive peritoneal cytology in 64 endometrial cancer patients who had hysteroscopy versus those who did not.…”

Hystéroscopie diagnostique et risque de contamination péritonéale par les cellules tumorales

“…D'autres études n'ont pas démontré de différence significative dans les taux de survie chez les patientes ayant un carcinome endométrial de stade I en fonction de la cytologie péritonéale [10,13,22]. Selon Obermair et al [23], il n'y a pas de différence entre les taux de survie sans récidive à cinq ans chez les patientes ayant eu (92,4 %) ou non (84,7 %) une hystéroscopie diagnostique dans leur bilan initial.…”