The oncological safety of hysteroscopy in the diagnosis of early-stage endometrial cancer: An Israel gynecologic oncology group study

Namazov, Ahmet; Gemer, Ofer; Helpman, Limor; Hag-Yahia, Nasreen; Eitan, Ram; Raban, Oded; Vaknin, Zvi; Leytes, Sophia; Lavie, Ofer; Agarwal, Amit; Levy, Tally; Volodarsky, Michael; Shachar, Inbar Ben; Atlas, Ilan; Bruchim, Ilan; Ben-Arie, Alon

doi:10.1016/j.ejogrb.2019.10.042

Cited by 15 publications

(23 citation statements)

References 35 publications

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“…A subgroup analysis of 3 studies 4,17,19 that included patients with stages I-II (early stage) disease indicated that there was no obvious heterogeneity (I 2 = 0%) and no significant difference (OR, 1.50; 95% CI, 0.75-2.99; p = 0.25) (Figure 4).…”

Section: Resultsmentioning

confidence: 99%

Whether preoperative hysteroscopy increases the dissemination of endometrial cancer cells: A systematic review and meta‐analysis

Dong

Wang

Zhang

et al. 2021

J of Obstet and Gynaecol

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Aim: To determine whether hysteroscopy (HSC) increases the risk of intraperitoneal dissemination in endometrial cancer patients. Methods: We conducted a comprehensive review of multiple databases. Quality assessments of eligible studies were performed using the Newcastle-Ottawa and Jadad scales. Positive peritoneal cytology (PPC) as the outcome of interest was compared between endometrial cancer patients with and without HSC. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated as a measure of effects. Results: Three case-control studies and eight retrospective cohort studies included 3364 patients, of whom 1116 underwent preoperative HSC, which resulted in a significantly higher PPC rate (OR, 1.82; 95% CI, 1.31-2.54; p = 0.0004). I 2 was 11%, and the heterogeneity was acceptable. The difference between the groups with stages I-II was statistically insignificant (OR, 1.50; 95% CI, 0.75-2.99; p = 0.25). When liquid was used as the uterine distension medium during HSC and the intrauterine pressure was controlled under 80 mmHg, the difference between the two groups was also insignificant (OR, 1.18; 95% CI, 0.50-2.79; p = 0.71). However, when the intrauterine pressure exceeded 80 mmHg, the difference between the two groups was statistically significant (OR, 2.18; 95% CI, 1.28-3.73; p = 0.004). Conclusion:This meta-analysis indicates that preoperative HSC in patients with endometrial cancer may increase the risk of intraperitoneal dissemination of malignant cells, which may be associated with intrauterine pressure >80 mmHg but not with stages I-II. There is no reason to avoid HSC for the diagnosis of endometrial cancer, especially in early stages, but intrauterine pressure should possibly be controlled below 80 mmHg.

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Section: Resultsmentioning

confidence: 99%

Whether preoperative hysteroscopy increases the dissemination of endometrial cancer cells: A systematic review and meta‐analysis

Dong

Wang

Zhang

et al. 2021

J of Obstet and Gynaecol

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“…Another study analyzed a database of approximately 2000 women with types I and II EC and found no association between HSC and the disease progression, risk of dissemination, or increased mortality [29]. In 2019, a study evaluated 1300 women with stage I EC and after following them for an average of 52 months, found that the disease-free time, specific survival, or overall survival did not worsen in those who underwent HSC [28].…”

Section: Discussionmentioning

confidence: 99%

Is Diagnostic Hysteroscopy Safe for the Investigation of Type II Endometrial Cancer? A Retrospective Cohort Analysis

Ribeiro

Brito

Benetti‐Pinto

et al. 2021

Journal of Minimally Invasive Gynecology

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Study Objective: Although hysteroscopy (HSC) can be used for assessing the uterine cavity in women with suspected endometrial cancer (EC), it remains controversial as a procedure because it can potentially enhance the metastatic spread of cancer cells. Moreover, it is important to assess this hypothesis for type II EC, a more aggressive phenotype that usually presents with endometrial atrophy and has worse prognosis. Thus, we aimed to assess the prevalence of positive peritoneal cytology result in women with type II EC who underwent HSC as a diagnostic tool and to determine the factors associated with patient relapse/survival. Design: Retrospective cohort analysis (2002−2017). Setting: Tertiary, academic hospital. Patients: One hundred twenty-seven women with type II EC. Interventions: Diagnostic HSC (HSC) (n = 43) or dilation/curettage (D&C) (n = 84). Measurements and Main Results: Primary end point was the frequency of positive peritoneal cytology result. Survival curves were projected using the Kaplan-Meier method and compared using the log-rank test. Cox regression analysis with hazard ratio (HR) and 95% confidence intervals (CIs) were calculated to assess the factors related with the disease-free survival (DFS) and the disease-specific survival (DSS). Advanced cancer stage and greater vascular invasion appeared more frequently in the D&C group (p = .008 and p = .04, respectively). Positive peritoneal cytology result was present in 2 of 43 (4.6%) women following HSC and in 9 of 84 (10.7%) following D&C (p = .22). DFS and DSS curves did not statistically differ between the groups. Multivariate analysis for DFS revealed that advanced cancer stage (III and IV) (HR = 4.67; 95% CI, 2.34−9.34; p <.001) and advanced age (HR = 1.08; 95% CI, 1.04−1.13]; p <.001) were the factors associated with relapse. For DSS, advanced age (HR = 1.08; 95% CI, 1.05−1.12; p <.001), cancer stage III/IV (HR = 3.95; 95% CI, 2.18 −7.15; p <.001), and vascular invasion (HR = 2.47; 95% CI, 1.34−4.54; p = .004) increased the risk of mortality. Conclusion: Diagnostic HSC did not increase the rate of positive peritoneal cytology result at the time of surgical staging in this cohort of women with type II EC and is probably as safe as D&C.

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“…Eight studies were included in this study, including two RCTs (15,16) and six retrospective studies (17)(18)(19)(20)(21)(22). Both RCTs (15,16) described an adequate random sequence generation process and were classified as low risk (15,16).…”

Section: Results Of Quality Assessmentmentioning

confidence: 99%

“…The titles and abstracts of the records were screened according to inclusion and exclusion criteria. After full-text review, eight articles including two RCTs (15,16) and six cohort studies (17)(18)(19)(20)(21)(22) were eventually included in this study (Figure 1).…”

Section: Characteristics Of Retrieved Studiesmentioning

confidence: 99%

The Oncology Safety of Diagnostic Hysteroscopy in Early-Stage Endometrial Cancer: A Systematic Review and Meta-Analysis

Qin

et al. 2021

Front. Oncol.

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BackgroundHysteroscopy is becoming a common method for the diagnosis of uterine disorders in developed countries. However, hysteroscopy might worsen the prognosis of endometrial cancer because it could cause cancer dissemination into the peritoneal cavity through the fallopian tubes. Objective: The aim of this systematic review and meta-analysis was to explore the oncological safety of hysteroscopy for early-stage endometrial cancer.Search StrategyEligible studies were obtained from PubMed, Embase, and the Cochrane Library up to September 22, 2020.Selection CriteriaStudies which compared the oncological safety of hysteroscopy with other methods were included.Data Collection and AnalysisA total of 3980 patients were included in this study, of whom1357 patients had undergone hysteroscopy and2623 had not.Main ResultsThere was no significant association between hysteroscopy and worse prognosis in early-stage endometrial cancer [disease-free survival: log risk ratio(logRR) -0.22; 95% confidence interval (CI), -0.54 to 0.1; p=0.97; overall survival: logRR 0.03; 95% CI, -0.05 to 0.11; p=0.02; disease-specific survival: logRR 0.03; 95% CI, -0.03 to 0.10; p=0.00].ConclusionThis study suggests that hysteroscopy is a safe diagnostic and treatment method, and has no significant effect on the prognosis of early-stage endometrial cancer.Systematic Review RegistrationPROSPERO registration number: CRD42020193696.

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The oncological safety of hysteroscopy in the diagnosis of early-stage endometrial cancer: An Israel gynecologic oncology group study

Cited by 15 publications

References 35 publications

Whether preoperative hysteroscopy increases the dissemination of endometrial cancer cells: A systematic review and meta‐analysis

Whether preoperative hysteroscopy increases the dissemination of endometrial cancer cells: A systematic review and meta‐analysis

Is Diagnostic Hysteroscopy Safe for the Investigation of Type II Endometrial Cancer? A Retrospective Cohort Analysis

The Oncology Safety of Diagnostic Hysteroscopy in Early-Stage Endometrial Cancer: A Systematic Review and Meta-Analysis

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