Rate Of Positive Peritoneal Cytology Research Articles

Effects of preoperative diagnostic hysteroscopy on peritoneal cytology and prognosis in patients with non-endometrioid carcinoma

Objective: To explore the effects of preoperative hysteroscopic guided biopsy and segmental diagnosis and curettage on the risk of abdominal dissemination and prognosis of non-endometrioid carcinoma. Methods: The clinical and pathological data of 97 patients who underwent surgical treatment and were pathologically confirmed as non-endometrioid carcinoma (including serous carcinoma, clear cell carcinoma, mixed adenocarcinoma, and undifferentiated carcinoma, etc.) from October 2008 to December 2021 in Peking University People's Hospital, were collected for retrospective analysis. According to preoperative diagnostic methods, they were divided into hysteroscopic group (n=44) and non-hysteroscopic group (n=53). The impact of hysteroscopy examination on peritoneal cytology and prognosis was analyzed. Results: (1) There were no statistical differences in age, body mass index, tumor size, pathological characteristics, and treatment methods between the hysteroscopic group and the non-hysteroscopic group (all P>0.05), but the proportion of stage Ⅰ-Ⅱ patients in the hysteroscopic group was significantly higher than that in the non-hysteroscopic group [68% (30/44) vs 47% (25/53); χ2=4.32, P=0.038]. (2) Among 97 patients, 25 (26%, 25/97) of them were cytologically positive for ascites. The hysteroscopic group had a lower positive rate of peritoneal cytology than that in the non-hysteroscopy group, which was significantly different [11% (5/44) vs 38% (20/53); χ2=8.74, P=0.003]. Stratification according to surgical and pathological stages showed that the positive rate of peritoneal cytology in the hysteroscopic group (3%, 1/30) was lower than that in the non-hysteroscopic group (12%, 3/25) in the 55 patients with stage Ⅰ-Ⅱ, and that in the hysteroscopic group (4/14) was also lower than that in the non-hysteroscopic group (61%, 17/28) in the 42 patients with stage Ⅲ-Ⅳ. There were no significant differences (all P>0.05). (3) The 5-year disease-free survival (DFS) rate of the hysteroscopic group and the non-hysteroscopic group were respectively 72.7% and 60.4%, and there was no significant difference between the two groups (P=0.186). After stratification according to staging, the 5-year DFS rate were respectively 90.0% and 72.0% (P=0.051) between the hysteroscopic and non-hysteroscopic groups of patients in stage Ⅰ-Ⅱ, and 35.7% and 50.0% (P=0.218) between the hysteroscopic and non-hysteroscopic groups of patients in stage Ⅲ-Ⅳ, in which there were not statistically significant differences. The 5-year overall survival (OS) rate were respectively 86.4% and 81.1% between the hysteroscopic group and the non-hysteroscopic group, with no significant difference between the two groups (P=0.388). The 5-year OS rate were respectively 93.3% and 96.0% in the hysteroscopic group and non-hysteroscopic group for patients with stage Ⅰ-Ⅱ(P=0.872), and 71.4% and 67.9% in the hysteroscopic group and non-hysteroscopic group in patients with stage Ⅲ-Ⅳ (P=0.999), with no statistical significance. Conclusions: Diagnostic hysteroscopy do not increase the rate of positive peritoneal cytology result at the time of surgery in this cohort, and no significant correlation between preoperative hysteroscopy examination and poor prognosis of non-endometrioid carcinoma is observed. Therefore, preoperative hysteroscopic guided biopsy and segmental diagnosis and curettage in non-endometrioid carcinoma maybe safe.

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

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. Retrospective cohort analysis (2002-2017). Tertiary, academic hospital. One hundred twenty-seven women with type II EC. Diagnostic HSC (HSC) (n = 43) or dilation/curettage (D&C) (n = 84). 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. 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.

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

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.

Does hysteroscopy worsen prognosis in women with type II endometrial carcinoma?

BackgroundPrior studies evaluating the impact of hysteroscopy on outcomes in endometrial cancer have predominantly evaluated type I tumors. We sought to evaluate whether hysteroscopy worsens prognosis in type II endometrial cancer.MethodsA retrospective cohort analysis of 140 patients from two institutions with type II endometrial cancer was performed. Women who underwent either diagnostic hysteroscopy (HSC) or dilation and curettage (D&C) for cancer diagnosis from June 2001 until June 2010 were included. The clinical and pathologic characteristics, including peritoneal cytology results were reviewed. The primary endpoint was disease-specific survival (DSS). The exposure of interest was hysteroscopy. Survival curves were projected using the Kaplan-Meier method and compared using the log-rank test.ResultsThere was no difference in age, histology, stage, depth of myometrial invasion, adnexal involvement, or nodal metastasis between HSC and D&C patients. Positive cytology was found in 16/54 (30%) patients following HSC and in 10/86 (12%) following D&C (p = 0.008). Fourteen patients with stage I and II disease had positive peritoneal cytology, with 11/40 (27.5%) patients in the HSC group and 3/59 (5%) patients in the D&C group(p = 0.002). Median DSS was clinically different for the HSC and D&C groups, but statistical significance was not reached (53 versus 63.5 months, p = 0.34). For stage I and II patients, 18/99 (18%) were dead of EC, with a median DSS of 60 months for HSC and 71 months for D&C (p = 0.82). Overall 46 (33%) patients developed a recurrence, with 18/54 (33%) in the HSC group compared to 28/86 (32%) in the D&C group (p = 0.92). There was no difference in recurrence location between groups.ConclusionsDiagnostic hysteroscopy significantly increased the rate of positive peritoneal cytology at the time of surgical staging in this cohort of patients with type II EC. However, we were unable to detect a difference in prognosis as measured by DSS.

Incidence of positive peritoneal cytology in patients with endometrial carcinoma after hysteroscopy vs. dilatation and curettage.

BackgroundThe aim of the study was to compare the frequency of positive peritoneal washings in endometrial cancer patients after either hysteroscopy (HSC) or dilatation and curettage (D&C).Patients and methodsWe performed a retrospective analysis of 227 patients who underwent either HSC (N = 144) or D&C (N = 83) and were diagnosed with endometrial carcinoma at the University Medical Centre Maribor between January 2008 and December 2014. The incidence of positive peritoneal cytology was evaluated in each group.ResultsThere was no overall difference in the incidence of positive peritoneal washings after HSC or D&C (HSC = 13.2%; D&C = 12.0%; p = 0.803). However, a detailed analysis of stage I disease revealed significantly higher rates of positive peritoneal washings in the HSC group (HSC = 12.8%; D&C = 3.4%; p = 0.046). Among these patients, there was no difference between both groups considering histologic type (chi-square = 0.059; p = 0.807), tumour differentiation (chi-square = 3.709; p = 0.156), the time between diagnosis and operation (t = 0.930; p = 0.357), and myometrial invasion (chi-square = 5.073; p = 0.079).ConclusionsAlthough the diagnostic procedure did not influence the overall incidence of positive peritoneal washings, HSC was associated with a significantly higher rate of positive peritoneal cytology in stage I endometrial carcinoma compared to D&C.

Effects of Uterine Manipulation on Surgical Outcomes in Laparoscopic Management of Endometrial Cancer

This study aimed to evaluate the influence of intrauterine manipulation on the surgical outcome in patients with early-stage endometrial cancer treated with 2 different laparoscopic approaches. In a randomized parallel trial, 110 patients with clinical stage I endometrial cancer were randomly assigned for laparoscopic staging surgery with (group A, 55) or without (group B, 55) the use of a uterine manipulator (RUMI), between June 2009 and June 2011. Two sets of peritoneal washings were obtained, 1 before and 1 after the insertion of the uterine manipulator. Primary end points were the rates of positive cytology and lymphovascular space invasion. No difference was detected in patient characteristics between the groups. Mean operative time, estimated blood loss, and postoperative complications were similar between the groups. Group A had a similar incidence of lymphovascular space invasion compared with group B (12.7% vs 9.1%, respectively; P = 0.761). Four patients (7.3%) in group A had positive peritoneal cytology in the initial washing. One of these patients was classified as stage IIIA. One patient in group B was positive in the second washing. The agreement rate between the 2 sets of washings for both groups was 98.2%. During the median follow-up of 19 months, 6 patients had tumor recurrence without significant difference between the groups. Despite concerns that the use of uterine manipulators may predispose the spread of early-stage disease, insertion of such uterine-manipulating systems did not increase rate of positive peritoneal cytology or lymphovascular space invasion in this study.

Effect of hysteroscopy on the peritoneal dissemination of endometrial cancer cells: a meta-analysis

To determine whether preoperative hysteroscopic examination increases the risk for peritoneal dissemination of endometrial cancer cells and the effect of hysteroscopy on disease prognosis. Meta-analysis. Literature search conducted via domestic and international databases for studies on preoperative hysteroscopy. A total of 2,944 women with endometrial cancer enrolled in selected studies. Preoperative hysteroscopic examination for 1,099 patients. Rate of positive peritoneal cytology. Of 308 studies retrieved, 19 were included in the meta-analysis. The meta-analysis demonstrated that hysteroscopy resulted in a statistically significantly higher rate of positive peritoneal cytology results compared with no hysteroscopy. In addition, when a liquid medium was used for uterine distention during hysteroscopy, the difference between the two groups remained statistically significant. However, no statistically significant differences were seen when inflation pressure reached or exceeded 100 mm Hg or when the cancer stage was early. Trials that examined long-term outcomes reported no statistically significant differences in disease prognosis between the two groups. Hysteroscopic examination before surgery in patients with endometrial cancer may increase the risk of dissemination of malignant cells into the peritoneal cavity. The risk was statistically significantly associated with the use of a liquid medium for uterine cavity distention but not with early-stage disease. There is no evidence to support an association between preoperative hysteroscopic examination and a worse prognosis. There is no reason to avoid diagnostic hysteroscopy before to surgery in patients with endometrial cancer, especially in early stages.

Histologic Artifacts in Abdominal, Vaginal, Laparoscopic, and Robotic Hysterectomy Specimens

Total laparoscopic hysterectomy (LH) is a minimally invasive technique, which results in comparable morbidity and better cosmesis compared with total abdominal hysterectomy. The literature is discrepant as to whether it is associated with a higher incidence of positive peritoneal cytology compared with total abdominal hysterectomy and recently, associated artifacts, including vascular pseudoinvasion (VPI), have been described. A retrospective histopathologic review of 266 hysterectomy specimens from 2 centers was performed. The observers, blinded to the surgical technique, assessed for the presence of artifactual changes including disruption of the endometrial lining, nuclear crush artifact, VPI, endomyometrial cleft artifact with or without epithelial displacement, inflammatory debris within vessels, serosal carryover, and intratubal contaminants. In addition, the rates of positive peritoneal washings over a 5-year period, and the use of immunohistochemistry (IHC) to aid in cell typing over a 3-year period, were compared between hysterectomies in which a uterine manipulator (UM) device had and had not (nonmanipulated hysterectomies) been used. The hysterectomies were performed for malignant (n=160) and benign (n=102) uterine disease or for ovarian or cervical disease (n=4), and included total abdominal (n=108), vaginal (n=17), laparoscopy-assisted vaginal (n=24), laparoscopy converted to laparotomy (n=10), nonrobotic laparoscopic (n=51), and robot-assisted laparoscopic (n=56) hysterectomies. One hundred and two (38%) of these hysterectomies involved the use of a UM. Artifactual changes of disruption of the endometrial lining, endomyometrial clefts, intratubal contaminants, nuclear crush artifact, intravascular inflammatory debris, and VPI were significantly more common with LH and with the use of a UM, independent of whether the endometrial pathology was benign or malignant. IHC to aid in endometrial cancer subtyping was more likely to be used in manipulated hysterectomies (P=0.0166). Furthermore, peritoneal washings were significantly more likely to be positive in hysterectomies in which a UM had been used (P=0.0061). Histologic artifacts are significantly more common in LH and specifically in hysterectomies in which a UM is used. Such artifacts impair the pathologists' interpretation of cell type requiring an increased use of IHC, and displaced epithelial fragments present within vessels or artifactual clefts may result in the misinterpretation of prognostic and staging parameters. Furthermore, there is a significantly higher rate of positive peritoneal cytology in cases that are subjected to uterine manipulation, suggesting dissemination of malignant cells into the abdominal cavity. The clinical significance of this finding needs to be determined.

Sonography and hysteroscopy for endometrial carcinoma and its precursors

The transvaginal sonography is a non invasive diagnostic method to evaluate the endometrium. It has a high reliability in the diagnosis of endometrial carcinoma, in the assessment of the depth of myometrial invasion as well as in preoperative staging. Patients with an episode of postmenopausal vaginal bleeding and an endometrial thickness (double layer) less-than-or-equal 4 mm should be controlled by transvaginal ultrasound examination after 3 month. In case of a endometrial thickness > 4 mm or in case of a persistent bleeding a histologic assessment should be obtained. Because of the highest sensitivity and specificity a hysteroscopic biopsy or a diagnostic hysteroscopy with subsequent D & C should be performed. Vaginal bleeding under hormonal replacement therapy should not be regarded to have more importance than vaginal bleeding in patients without HRT. After the current consensus hysteroscopy causes only a slightly increase in the rate of positive peritoneal cytology. This phenomenon seems to be of no influence on the disease free survival rate.

Peritonealzytologie nach Flüssigkeitshysteroskopie bei Patientinnen mit Endometriumkarzinom

Purpose: The aim of this study was to determine the rate of positive peritoneal cytology in patients with endometrial carcinoma who underwent preceding hysteroscopy. Material and Methods: 33 patients with endometrial cancer underwent diagnostic fluid hysteroscopy, on the average 11 days (3-30) before surgery. The rate of positive peritoneal cytology was compared with that in 1278 patients in the literature with carcinoma limited to the uterus without preceding hysteroscopy. Results: Three of 31 patients (9.7%) had positive peritoneal cytology. All three patients were among the 28 patients with carcinoma limited to the uterus without extension to the uterine serosa (10.7%). The rate of positive peritoneal cytology in 1278 patients in the literature without preoperative irradiation or hysteroscopy was 8.5%. Conclusion: The rate of positive peritoneal cytology in patients with endometrial carcinoma after diagnostic fluid hysteroscopy is similar to that in patients without preceding hysteroscopy.