Is there a real risk in patients with endometrial carcinoma undergoing diagnostic hysteroscopy (HSC)?

Objective: The penetration of distention medium into the peritoneal cavity as well as directly into the bloodstream via injured endometrial vessels occurs in a great proportion of patients at hysteroscopy (HSC). This may cause potential risk of dissemination of the malignant cells of endometrial cancer patients. To evaluate the real risk of a poorer prognosis of these patients a prospective multicentric study was started in 1998.

Material and methods: Two groups of patients with endometrial carcinoma have been compared. The diagnosis was made in the study group by HSC and targeted biopsy, while in the control group by classical D&C. At the end of the HSC procedure puncture of the cul de sac was performed and the fluid obtained was cytologically examined. In both groups peritoneal lavage was performed at the beginning of the subsequent operation and the collected fluid was again cytologically examined. In the first phase of the study the cytology findings in both groups were compared. In the second phase which is planned for the next five years. the results of follow-up of both groups of patients will be evaluated.

Results: The results were evaluated in 134 patients with HSC and in 61 patients with D&C. In the study group a positive finding of malignant cells from the cul de sac was found in four patients (5.3%), a suspect finding in eight patients (10.7%), and a negative finding in 63 patients (84%). In the remaining 59 patients with HSC no peritoneal fluid was obtained. In the fluid from lavage at the beginning of the operation in the same group of HSC patients, a positive finding of malignant cells was found in 12.1%, a suspect finding in 18.2%, and a negative finding in 69.7%. In the control group (after D&C) the fluid from lavage contained malignant cells in eight patients (13.6%), suspect cells in 12 patients (20.3%), and no malignant cells in 39 patients (66.1%). Both groups were comparable for clinical stages of disease.

Conclusions: Our results suggest that HSC does not increase the risk of penetration of tumour cells into the peritoneal cavity more than estimates in D&C.

Endometrial cancer; Hysteroscopy; D&C; Malignant cell seeding

[1] Chen L. M., McGonigle K., Berek J. S.: "Endometrial cancer: recent developments in evaluation and treatment". Oncology, 1999, 13, 1665.

[2] Creasman W. T.,M orrow C. P., Bundy B. N.,H omesley H. D., Graham J.E.,H eller P. B.: "Surgical pathologic spread patterns of endometrial cancer". Cancer, 1987, 60, 2035.

[3] Egarter C., Krestan C., Kurz C.: "Abdominal dissemination of malignant cells with hysteroscopy". Gynecologic Oncology, 1996, 63, 143.

[4] Harouny V R.,S utton G. P.,C larkS .A .,G eisler H.E .,S tehman F B.,E hrlich C.E .: "The importance of peritoneal cytology in endometrial carcinoma". Obstetrics and Gynecology, 1988, 72, 394.

[5] Holub Z.: "Problematika karcinomu endometria na XIV Kongresu FIGO v Montrealu". Gynekolog., 1994, 6, 216.

[6] Holub Z., Krause J.: "Evaluation of prognostics factors before surgery of endometrial carcinoma". Ceskci Gynekologie，1995. 60, 83.

[7] Kennedy A. W., Webster K. D., Nunez C.. Bauer L. J.: "Pelvic washings for cytologic analysis in endometrial adenocarcinoma" J. Reprod. Med., 1993, 38, 637.

[8] Lurain J. R.,R umsey N. K.,S chink J. C.,W allemark C. B., Chmiel J. S.: "Prognostic significance of positive peritoneal cytology in clinical stage I adenocarcinoma of the endometrium" Obstetrics and Gynecology, 1989, 74, 175.

[9] Neis K. J.. Brandner P.,H epp H.: "Hysteroscopy -Textbook and Atlas". Thieme Medical Publishers, Inc. New York, 23.

[10] Neis K. J., Brander P., Keppeler U.:'Tumor cell seeding caused by hysteroscopy?". Geburtshilfe Frauenheilkd, 1994, 54, 651.

[11] Romano S.,S himoni Y.,M uralee D.,S halev E.: "Retrograde seeding of endometrial carcinoma during hysteroscopy". Gynecologic Oncology, 1992, 44, 116.

[12] Rose P. G.,M endelsohn G., Kornbluth I.: "Hysteroscopic d1ssemination of endometrial carcinoma". Gynecologic Oncology, 1998, 71, 145.

[13] Sagawa T., Yamada H.,S akuragi N.,F ujimoto S.: "A companson between the preoperative and operative findings of peritoneal cytology in patients with endometrial cancer". Asia Oceania J. Obstet. Gynecol., 1994, 20, 39.

[14] Schmitz M. J., Nahhas W. A.: "Hysteroscopy may transport mali－gnant cells into the peritoneal cavity". Eu,: J. Gynecol. Oncol., 1994, 15, 21.

[15] Spiewankiewicz B.,S telmachow J., Sawicki W.,Kietlinska Z: "Hysteroscopy with selective endometrial sampling after unsuccessful dilatation and and curettage in diagnosis of symptomatic endometrial hyperplasias". Eur. J. Gynaecol. Oncol., 1995, 16,26.

[16] Turner D.A .,G ershenson D. M.,A tkinson N.,S neige N.,W harton T: "The prognostic significance of peritoneal cytology for stage Iendometrial cancer". Obstetrics and Gynecology, 1989, 74, 775.

[17] Vecek N.. Marinovic T., Ivie J., Jukic S., Nola M., Dzanic-Cema lovic N.: "Prognostic impact of peritoneal cytology in patients with endometrial carcinoma". Eur. J. Gynaecol. Oncol., 1993, 14, 380.

[18] Zeman V.,A damkova V.: "Plasma-thrombin cytoblocks m pneumological cytodiagnosis of tumors". Stadia pneumologia et phtiseologica Cechoslovaca, 1981, 41, 411.