Oncological safety of hysteroscopy in endometrial cancer

Abstract

ObjectiveIt has been suggested that the manipulation of neoplastic tissue during hysteroscopy may lead to dissemination of tumor cells into the peritoneal cavity and worsen prognosis and overall survival. The goal of this study was to assess the oncological safety comparing hysteroscopy to Pipelle blind biopsy in the presurgical diagnosis of patients with endometrial cancer.MethodsWe performed a retrospective multicentric study among patients who had received primary surgical treatment for endometrial cancer. A multivariate statistical analysis model was used to compare relapse and survival rates in patients who had been evaluated preoperatively either by hysteroscopy or Pipelle biopsy. The relapse rate, disease-free survival, and overall survival were assessed as the main outcomes. The histological type, tumor size, myometrial invasion, International Federation of Gynecology and Obstetrics (FIGO) stage, surgical approach, use of a uterine manipulator, and adjuvant treatment were also included in the analysis.ResultsA total of 1731 women from 15 centers were included: 1044 in the hysteroscopy group and 687 in the Pipelle sampling group. 225 patients relapsed during the 10 year follow-up period: 139 (13.3%) in the hysteroscopy group and 86 (12.4%) in the Pipelle sampling group. There is no evidence of an association between the use of hysteroscopy as a diagnostic method and relapse rate (HR 1.24, 95% CI 0.92 to 1.66; p=0.16), lower disease-free survival (HR 1.23, 95% CI 0.92 to 1.66; p=0.15), or overall survival (HR 0.95, 95% CI 0.70 to 1.29; p=0.76).ConclusionHysteroscopy is a safe diagnostic method for patients with endometrial cancer with no impact on oncological outcomes when compared with sampling by Pipelle.

OS and DFS are affected by different diagnostic methods and hysterectomy procedures in endometrial cancer patients: A single‐center retrospective study

“… 22 Moreover, a recent study published by Quintana‐Bertó R et al compared relapse and survival rates in 1731 women who had been evaluated by either pipelle biopsy or hysteroscopy in a retrospective multicentric study and found no impact on oncological outcomes. 23 The present study reports agree with these findings.…”

Safety of assisted reproductive techniques in gynecological cancer patients

“…There is controversy as to whether the hysteroscopic approach to the diagnosis and treatment of endometrial cancer could theoretically increase the risk of dissemination compared to alternative diagnostic methods (Pipelle blind biopsy or dilation and curettage). However, a recent review of over 1700 cases showed no association between hysteroscopic diagnosis and relapse rate, disease-free survival or overall survival [9 ▪ ].…”

Impact of diagnostic hysteroscopy on peritoneal washing status and survival rate of patients with endometrial cancer

“…However, it does not impact the recurrence, overall survival or disease-free survival rate [8,9]. On the other hand, there are other studies where this correlation has not been observed [10,11].…”