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

Abstract

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.

Oncological Safety of Diagnostic Hysteroscopy for Apparent Early-Stage Type II Endometrial Cancer: A Multicenter Retrospective Cohort Study

“…Whether the malignant cells disseminated into the peritoneal cavity during diagnostic hysteroscopy can survive, colonize, invade the normal tissue, and worsen the prognosis of patients is unknown. A systematic review and meta-analysis by Du et al showed that for endometrial cancer, although can increase the risk of spreading of malignant cells, diagnostic hysteroscopy did not worsen the prognosis (13). With 127 type II endometrial cancer cases included, the study conducted by Ribeiro et al also reported that compared with traditional D&C, diagnostic hysteroscopy did not increase the risk of recurrence and all-cause death (35).…”

“…A systematic review and meta-analysis by Du et al. showed that for endometrial cancer, although can increase the risk of spreading of malignant cells, diagnostic hysteroscopy did not worsen the prognosis ( 13 ). With 127 type II endometrial cancer cases included, the study conducted by Ribeiro et al.…”

“…They think that in the process of diagnostic hysteroscopy, the elevated pressure in the uterine cavity may increase the risk of dissemination of cancer cells ( 11 , 12 ). To date, however, many published studies have agreed that diagnostic hysteroscopy, although it can increase the spread of tumor cells into the peritoneal cavity, does not deteriorate the prognosis of endometrial cancer ( 13 – 16 ). But, it is worth noting that in these studies, almost all the included cases were low-risk endometrial cancer ( 14 – 16 ).…”

New boundaries for fertility sparing management in endometrial cancer

“…One of the largest retrospectives multicentric studies published to date, that was based in a series of 1731 women of whom 1044 were diagnosed with hysteroscopy and 687 with Pipelle biopsy, revealed that there was no association of hysteroscopy with the risk of relapse (hazards ratio (HR) 1.24, 95% confidence interval [CI] 0.92 to 1.66; P ¼ 0.16) or overall survival (HR 0.95, 95% CI 0.70 to 1.29; P ¼ 0.76) [51]. Several other smaller cohorts have been published that were summarized recently in a systematic review that included 3,980 patients of whom whom1357 patients had undergone hysteroscopy and2623 had not [52]. The study revealed that there was no association of hysteroscopy with disease free survival and overall survival, therefore, denoting that it should be considered a safe diagnostic and treatment method for patients with early-stage endometrial carcinoma.…”

Pain relief in hysteroscopy

“…It enables visualisation of the uterine cavity and is more accurate than pelvic ultrasound in assessing the endometrial cavity [1][2][3][4] . It has a high diagnostic accuracy for endometrial cancer and is not associated with worse prognosis in early-stage endometrial cancer 5 . Performing hysteroscopic procedures in an outpatient setting reduces the need for operative theatres and hence healthcare costs [6][7][8] .…”