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Diagnostic hysteroscopy safe in women with endometrial cancer

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Preoperative hysteroscopy can be safely used as a diagnostic tool in women with endometrial cancer, according to a report in the April 30th American Journal of Obstetrics and Gynecology.

“Our data is a valuable addition to the literature, as it underscores the safety of this procedure,” Dr. Jennifer E. Soucie from University of Calgary, Calgary, Alberta, Canada told Reuters Health in an email. “Physicians can assure their patients that a large cohort study that spanned 10 years showed no increased risk of upstaging endometrial cancer and no effect on survival when hysteroscopy was used as the diagnostic tool.”

There have been lingering concerns that introduction of high pressure gas or fluid into the uterine cavity to produce distension during hysteroscopy could facilitate the dissemination of malignant cells in women with endometrial cancer, but earlier studies have yielded inconclusive results.

Dr. Soucie and colleagues evaluated whether preoperative hysteroscopy had an effect on subsequent surgical staging and, ultimately, mortality, in a retrospective cohort analysis of data on 2331 women with endometrial cancer in the Alberta Cancer Registry.

About a third of the women (672/1972 with complete staging, 34.1%) had had a hysteroscopy performed.

The rate of stage III disease (one of the primary endpoints of the study) did not differ significantly between women who had undergone hysteroscopy (7.1%) and who had not undergone hysteroscopy (6.5%).

Moreover, the percentage of women who had died (the other primary endpoint) was similar for those who had undergone hysteroscopy (13.2%) and those who had not (15.2%).

Among women who had died, there were no significant differences between the groups in the proportion of women with stage III disease or in the proportion of women dying of “female genital organ” cancer.

“I do not have reservations about the use of hysteroscopy as a diagnostic tool in women for whom endometrial cancer must be ruled out,” Dr. Soucie concluded. “In some cases, an office endometrial biopsy may not be adequate. Hysteroscopy allows for direct visualization and directed biopsy and can improve our detection rate when other less invasive procedures have failed.”


The risk of diagnostic hysteroscopy in women with endometrial cancer

Am J Obstet Gynecol 30 April 2012.