Is Diagnostic Hysteroscopy Safe for the Investigation of Type 2 Endometrial Cancer? a Retrospective Cohort Analysis

Abstract

Study Objective Although hysteroscopy can be used for assessing the uterine cavity in women with suspected, endometrial cancer, it remains controversial as a procedure that can enhance metastasis spread. Endometrial cells may shed during hysteroscopy and be passively transported with fluid into the peritoneal cavity. Moreover, it is important to assess this hypothesis into type 2 endometrial cancer, a more aggressive phenotype that usually presents with endometrial atrophy and worse prognosis. Thus, we aimed to assess the prevalence of positive peritoneal cytology in type II endometrial cancer in women undergoing hysteroscopy as a diagnostic tool and determine their prognosis. Design Retrospective cohort analysis (2002-2017). Setting Tertiary, academic hospital. Patients or Participants 127 women with type II endometrial cancer. Interventions Diagnostic hysteroscopy (HSC)(n=43) or dilation/curettage (D&C)(n=84). Measurements and Main Results Clinical and pathologic characteristics, including peritoneal cytology results were reviewed. Survival curves were projected using the Kaplan-Meier method and compared using the log-rank test. Cox regression analysis with hazard ratio plus 95%confidence intervals were calculated to assess factors related to disease-free survival (DFS). There was no difference with regard to age between the groups. The D&C group showed a higher frequency of advanced staging and greater vascular invasion (p = 0.008 and p = 0.04 respectively). Positive cytology was found in 2/43 (4.6%) women following HSC and in 9/84 (10.7%) following D&C (p = 0.22). There was no statistically significant difference in the survival curve between groups. Multivariate analysis for DFS has shown that advanced staging (III and IV) (HR=3.89[1.98-7.66];p<0.001), advanced age (HR=1.073[1.028-1.119];p=0.001) and vascular invasion (OR=3.01[1.53-5.91];p=0.001) increases the risk of recurrence. Conclusion Diagnostic HSC did not increase the rate of positive peritoneal cytology at the time of surgical staging in this cohort of women with type II endometrial cancer and presented equal safety when compared to D&C. Although hysteroscopy can be used for assessing the uterine cavity in women with suspected, endometrial cancer, it remains controversial as a procedure that can enhance metastasis spread. Endometrial cells may shed during hysteroscopy and be passively transported with fluid into the peritoneal cavity. Moreover, it is important to assess this hypothesis into type 2 endometrial cancer, a more aggressive phenotype that usually presents with endometrial atrophy and worse prognosis. Thus, we aimed to assess the prevalence of positive peritoneal cytology in type II endometrial cancer in women undergoing hysteroscopy as a diagnostic tool and determine their prognosis. Retrospective cohort analysis (2002-2017). Tertiary, academic hospital. 127 women with type II endometrial cancer. Diagnostic hysteroscopy (HSC)(n=43) or dilation/curettage (D&C)(n=84). Clinical and pathologic characteristics, including peritoneal cytology results were reviewed. Survival curves were projected using the Kaplan-Meier method and compared using the log-rank test. Cox regression analysis with hazard ratio plus 95%confidence intervals were calculated to assess factors related to disease-free survival (DFS). There was no difference with regard to age between the groups. The D&C group showed a higher frequency of advanced staging and greater vascular invasion (p = 0.008 and p = 0.04 respectively). Positive cytology was found in 2/43 (4.6%) women following HSC and in 9/84 (10.7%) following D&C (p = 0.22). There was no statistically significant difference in the survival curve between groups. Multivariate analysis for DFS has shown that advanced staging (III and IV) (HR=3.89[1.98-7.66];p<0.001), advanced age (HR=1.073[1.028-1.119];p=0.001) and vascular invasion (OR=3.01[1.53-5.91];p=0.001) increases the risk of recurrence. Diagnostic HSC did not increase the rate of positive peritoneal cytology at the time of surgical staging in this cohort of women with type II endometrial cancer and presented equal safety when compared to D&C.