Does hysteroscopy produce intraperitoneal spread of endometrial cancer cells?

Hysteroscopy is the tool of choice for the evaluation of the endometrial cavity, including the assessment of abnormal uterine bleeding (AUB). The combination of endometrial biopsy and diagnostic hysteroscopy could replace dilation and curettage in most patients. However, hysteroscopy might disseminate endometrial cells into the peritoneum, thereby potentially raising the stage and decreasing the survival of a patient with endometrial cancer. The purpose of this article is to explore the dilemma of whether hysteroscopy produces intraperitoneal spread of endometrial cancer cells, and, if the answer is yes, what is the prognostic significance of isolated malignant cells in the peritoneal cavity. We conducted a literature search using MEDLINE using the following key words: hysteroscopy, endometrial carcinoma, and dissemination for the years 1980 through 2001. Retrospective data shows a correlation between fluid-based hysteroscopy and the presence of cancer cells in the peritoneal cavity. It cannot, however, be determined whether positive peritoneal washings are the result of hysteroscopy or whether the endometrial cells are found in the peritoneum as a result of other mechanism. Because no prospective, randomized studies have been performed on the dissemination of cancer cells by diagnostic hysteroscopy, no definite conclusions can be made concerning the risk of diagnostic hysteroscopy. In addition, the prognostic significance of isolated malignant cells in the peritoneal cavity of women with endometrial cancer is unclear. Although there might be an increased risk of peritoneal contamination by cancer cells after hysteroscopy, there is currently no evidence that these patients face worse prognosis than patients who have undergone other diagnostic procedures.