Prospective self-controlled study on prevention of hysteroscopic dissemination in endometrial carcinoma

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

Background

Prior 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.

Methods

A 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.

Results

There 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.

Conclusions

Diagnostic 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.

Conversion of intraperitoneal cytology during laparoscopic surgery of uterine cancer

INTRODUCTION

The laparoscopic surgery of uterine cancer is an oncological safe treatment option in early stage cancer. However, there are no data about whether laparoscopy can lead to intraperitoneal tumor cell dissemination. We aimed in our study to detect a possible cytological conversion during laparoscopic procedures.

METHODS

In this prospective study, we included all patients receiving laparoscopic treatment at the early stage endometrial and cervical cancer in the Department of Obstetrics and Gynecology at the University of the Saarland and obtained peritoneal wash for cytological examination at the beginning and at the end of laparoscopic surgery. All patients received stage-adjusted operative and adjuvant therapy.

RESULTS

We enrolled 43 patients [endometrial cancer (n = 24) and cervical cancer (n = 19)]. At the beginning of the operation, one patient with endometrial cancer and one patient with cervical cancer showed a positive cytology. One tumor cell conversion from negative to positive cytology during surgery was detected in a patient suffering from endometrial cancer stage FIGO Ia. The median duration of surgery was 191.8 ± 79.3 min. The average time of follow-up was 16.5 ± 10.3 month. At the end of data evaluation at December 2014, two patients (8.6 %) are suffering from recurrent disease, two patients died, none of these patients had a positive cytology. All patients with positive cytology are free of cancer.

CONCLUSION

During laparoscopic surgery of early stage endometrial and cervical cancer, only one conversion of cytology was detected, which proves that laparoscopy does not appear to increase the intraoperative tumor cell dissemination or rate of positive cytological results.

Hysteroscopy in endometrial cancer: new methods to evaluate transtubal leakage of saline distension medium

OBJECTIVE

This study was undertaken to evaluate transtubal fluid leakage after low pressure office saline solution hysteroscopy.

STUDY DESIGN

Forty stage I/II endometrial cancer patients were submitted to office hysteroscopy at the National Cancer Institute of Milan. Uterine cavity was distended by a 1000-mL saline solution bag, placed 50 cm above the patient's plane. After visualization of uterine cavity, a radiotracer (technetium Tc 99m) and patent blue dye were injected subendometrially. During the staging surgery peritoneal free fluid was analyzed to detect patent blue dye, technetium Tc 99m or free cancer cell by cytologic examination.

RESULTS

Technetium Tc 99m and patent blue dye were detected on the peritoneal surface and in the peritoneal fluid in 2 patients. In 1 of these peritoneal cytology was negative for cancer cells. Peritoneal cytology was positive in 2 cases.

CONCLUSION

The risk of transtubal fluid leakage during hysteroscopy is absent when performed with intrauterine pressure less than 40 mm Hg. Transtubal fluid leakage is not a synonym of cancer cell dissemination.