Office hysteroscopy and the risk of microscopic extrauterine spread in endometrial cancer

The aim of this study was to evaluate the incidence of tumor cell dissemination according to diagnostic modality in patients with endometrial cancer.

A retrospective study was conducted on 146 patients with endometrial cancer in whom one of the following diagnostic methods was performed: dilation and curettage (D&C, n=122) or office hysteroscopy (HSC, n=24). No selection or randomization of patients was applied to the groups. The presence of suspicious or positive peritoneal cytology as well as adnexal or abdominal metastases was considered the endpoint of this analysis.

Suspicious or positive peritoneal cytology was present in two patients (1.6%) after D&C and in three patients (12.5%) after HSC (chi2=4.2455; p<0.05). Adnexal metastases were present in 10 (8.2%) patients after D&C and in 1 patient (4.2%) after HSC (chi2=0.0680; p>0.05). Metastases to abdominal cavity were found in 3 (2.5%) patients after D&C and in 1 patient after HSC (chi2=0.0464; p>0.05). Lymph node metastases were found in 7 patients (5.7%) after D&C and in 2 patients (8.3%) after HSC (chi2=0.0004; p>0.05). After complete histopathological analysis, upstaging due to positive peritoneal cytology and adnexal or abdominal metastases was necessary in 11 patients (9.0%) from the D&C group and in 3 patients (12.5%) from the HSC group, but the difference was not significant (chi2=0.2227; p>0.05).

These data show that diagnostic HSC significantly increases the risk of positive peritoneal cytology, but not the risk of adnexal, abdominal or retroperitoneal lymph node metastases in patients with EC.