The risk of diagnostic hysteroscopy in women with endometrial cancer

Literature Review Article

 The risk of diagnostic hysteroscopy in women with endometrial cancer. Soucie JE, Chu PA, Ross S, Snodgrass T, Wood SL. Obstet Gynecol. 2009; 207: 71.e1-5.   

Review
Dr. John Preston Parry, M.D., M.P.H. 
 

This article addresses the question as to whether diagnostic hysteroscopy in women with endometrial cancer increases mortality or the likelihood of stage III disease. The study was designed as a retrospective cohort analysis linking endometrial cancer data from the Alberta Cancer Registry with hysteroscopy billing. For the 1,972 Stage IIIc2 (or less) endometrial cancer cases with complete staging that were included, 34% had undergone hysteroscopy. No statistically significant difference was noted in the likelihood of stage III disease for those that had undergone hysteroscopy relative to those that had not (7.1% vs 6.5%). There was also no statistically significant difference in mortality (13.2% vs 15.2%). The authors conclude that because hysteroscopy in patients with endometrial cancer does not exacerbate cancer stage or mortality, one should not avoid hysteroscopy in patients due to concern for potential dissemination of malignant cells.

Comments
Dr. Steven R. Lindheim, M.D., M.M.M.
 

Previous studies about the effect of hysteroscopy on peritoneal dissemination of malignant cells and upstaging of disease in women who have endometrial cancer reveal conflicting results with some suggesting a small increase in risk.  They have unfortunately been underpowered and with short follow up. This study sampled patients over 10 years, averaging 4 years of follow up  adds reassurance that hysteroscopy, which allows for direct visualization and directed biopsy, does not impose a significant risk of dissemination resulting in a higher staging of endometrial cancer. Hysteroscopy appears to be a safe diagnostic tool in women suspected of having endometrial cancer.

The above review and commentary on this article were written by SRS members. Publication of these summaries does not reflect endorsement of any particular procedure or treatment. Views expressed in these summaries do not necessarily reflect the views of SRS or ASRM.

 

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