Vol 88, No 10 (2017)
Review paper
Published online: 2017-10-31
Diagnostic hysteroscopy and the risk of malignant cells intraabdominal spread in women with endometrial cancer
Abstract
Although hysteroscopy is currently the undisputed gold standard for the examination of the uterine cavity in women with suspected endometrial cancer, it remains controversial as a procedure that can enhance metastasis spread. Endometrial cancer cells may shed during hysteroscopy and be passively transported with fluid flow into the peritoneal cavity. The paper presents the review of current knowledge regarding the risk of neoplasm metastases in women who had diagnostic hysteroscopy and the conditions that have to be met for the procedure to be safe. We searched PubMed, Ovid, Medline and Scopus databases for data published in the years 1985–2017. The following browsing criteria, the “MeSH headings”: hysteroscopy, endometrial cancer, intraperitoneal or metastatic spread were used to find relevant papers. Based on the current data analysis we conclude that (1.) diagnostic hysteroscopy performed in women with endometrial cancer, especially in its early stages, is a very useful, efficient and safe diagnostic method and (2.) the distension media used for endoscopic procedures in the uterine cavity must be strictly controlled for relatively low pressures to prevent the increase in risk of endometrial cancer intraperitoneal spread.
Keywords: hysteroscopyendometrial cancerintraabdominal cancer cells spread
References
- Pakish JB, Lu KH, Sun CC, et al. Endometrial Cancer Associated Symptoms: A Case-Control Study. J Womens Health (Larchmt). 2016; 25(11): 1187–1192.
- Dueholm M, Hjorth IM. Structured imaging technique in the gynecologic office for the diagnosis of abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol. 2017; 40: 23–43.
- Siegel RL, Miller KD, Fedewa SA, et al. Cancer Statistics, 2017. CA Cancer J Clin. 2017; 67(1): 7–30.
- van Hanegem N, Prins MMC, Bongers MY, et al. The accuracy of endometrial sampling in women with postmenopausal bleeding: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2016; 197: 147–155.
- Epstein E, Ramirez A, Skoog L, et al. Transvaginal sonography, saline contrast sonohysterography and hysteroscopy for the investigation of women with postmenopausal bleeding and endometrium > 5 mm. Ultrasound Obstet Gynecol. 2001; 18(2): 157–162.
- Dueholm M, Marinovskij E, Hansen ES, et al. Diagnostic methods for fast-track identification of endometrial cancer in women with postmenopausal bleeding and endometrial thickness greater than 5 mm. Menopause. 2015; 22(6): 616–626.
- Stachowicz N, Czekierdowski A, Daniłoś J, et al. [Three-dimensional sonoangiography in diagnostic of endometrial hyperplasia and carcinoma. An assessment of vascularization indices and endometrial volume]. Przegl Lek. 2005; 62(9): 827–829.
- Stachowiak G, Zając A, Pertynska-Marczewska M, et al. 2D/3D ultrasonography for endometrial evaluation in a cohort of 118 postmenopausal women with abnormal uterine bleedings. Ginekol Pol. 2016; 87(12): 787–792.
- Epstein E, Fischerova D, Valentin L, et al. Ultrasound characteristics of endometrial cancer as defined by the International Endometrial Tumor Analysis (IETA) consensus nomenclature - A prospective multicenter study. Ultrasound Obstet Gynecol. 2017 [Epub ahead of print].
- Hinchcliff EM, Esselen KM, Watkins JC, et al. The Role of Endometrial Biopsy in the Preoperative Detection of Uterine Leiomyosarcoma. J Minim Invasive Gynecol. 2016; 23(4): 567–572.
- Radwan P, Radwan M, Polać I, et al. Detection of intracavitary lesions in 820 infertile women: comparison of outpatient hysteroscopy with histopathological examination. Ginekol Pol. 2013; 84(10): 857–861.
- Sousa R, Silvestre M, Almeida e Sousa L, et al. Transvaginal ultrasonography and hysteroscopy in postmenopausal bleeding: a prospective study. Acta Obstet Gynecol Scand. 2001; 80(9): 856–862.
- Symonds I. Ultrasound, hysteroscopy and endometrial biopsy in the investigation of endometrial cancer. Best Pract Res Clin Obstet Gynaecol. 2001; 15(3): 381–391.
- Clark TJ, Voit D, Gupta JK, et al. Accuracy of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia: a systematic quantitative review. JAMA. 2002; 288(13): 1610–1621.
- Goldrath MH, Sherman AI. Office hysteroscopy and suction curettage: can we eliminate the hospital diagnostic dilatation and curettage? Am J Obstet Gynecol. 1985; 152(2): 220–229.
- Dueholm M, Hjorth IM, Secher P, et al. Structured Hysteroscopic Evaluation of Endometrium in Women With Postmenopausal Bleeding. J Minim Invasive Gynecol. 2015; 22(7): 1215–1224.
- Egarter C, Krestan C, Kurz C. Abdominal dissemination of malignant cells with hysteroscopy. Gynecol Oncol. 1996; 63(1): 143–144.
- Obermair A, Geramou M, Gucer F, et al. Does hysteroscopy facilitate tumor cell dissemination? Incidence of peritoneal cytology from patients with early stage endometrial carcinoma following dilatation and curettage (D & C) versus hysteroscopy and D & C. Cancer. 2000; 88(1): 139–143.
- Bradley WH, Boente MP, Brooker D, et al. Hysteroscopy and cytology in endometrial cancer. Obstet Gynecol. 2004; 104(5 Pt 1): 1030–1033.
- Takac I, Zegura B. Office hysteroscopy and the risk of microscopic extrauterine spread in endometrial cancer. Gynecol Oncol. 2007; 107(1): 94–98.
- Lo KWK, Cheung TH, Yim SF, et al. Hysteroscopic dissemination of endometrial carcinoma using carbon dioxide and normal saline: a retrospective study. Gynecol Oncol. 2002; 84(3): 394–398.
- Baker VL, Adamson GD. Threshold intrauterine perfusion pressures for intraperitoneal spill during hydrotubation and correlation with tubal adhesive disease. Fertil Steril. 1995; 64(6): 1066–1069.
- Levêque J, Goyat F, Dugast J, et al. [Value of peritoneal cytology after hysteroscopy in endometrial adenocarcinoma stage I]. Contracept Fertil Sex. 1998; 26(12): 865–868.
- Polyzos NP, Mauri D, Tsioras S, et al. Intraperitoneal dissemination of endometrial cancer cells after hysteroscopy: a systematic review and meta-analysis. Int J Gynecol Cancer. 2010; 20(2): 261–267.
- Chang YN, Zhang Y, Wang YJ, et al. Effect of hysteroscopy on the peritoneal dissemination of endometrial cancer cells: a meta-analysis. Fertil Steril. 2011; 96(4): 957–961.
- de Sousa Damião R, Lopes RG, Dos Santos ES, et al. Evaluation of the risk of spreading endometrial cell by hysteroscopy: a prospective longitudinal study. Obstet Gynecol Int. 2009; 2009: 397079.
- Cicinelli E, Tinelli R, Colafiglio G, et al. Risk of long-term pelvic recurrences after fluid minihysteroscopy in women with endometrial carcinoma: a controlled randomized study. Menopause. 2010; 17(3): 511–515.
- Selvaggi L, Cormio G, Ceci O, et al. Hysteroscopy does not increase the risk of microscopic extrauterine spread in endometrial carcinoma. Int J Gynecol Cancer. 2003; 13(2): 223–227.
- Revel A, Tsafrir A, Anteby SO, et al. Does hysteroscopy produce intraperitoneal spread of endometrial cancer cells? Obstet Gynecol Surv. 2004; 59(4): 280–284.
- Biewenga P, de Blok S, Birnie E. Does diagnostic hysteroscopy in patients with stage I endometrial carcinoma cause positive peritoneal washings? Gynecol Oncol. 2004; 93(1): 194–198.
- Kudela M, Pilka R. Is there a real risk in patients with endometrial carcinoma undergoing diagnostic hysteroscopy (HSC)? Eur J Gynaecol Oncol. 2001; 22(5): 342–344.
- Soucie JE, Chu PA, Ross S, et al. The risk of diagnostic hysteroscopy in women with endometrial cancer. Am J Obstet Gynecol. 2012; 207(1): 71.e1–71.e5.
- Dvorská M, Driák D, Svandová I, et al. [Significance of hysteroscopic resection in diagnostics of endometrial cancer]. Ceska Gynekol. 2010; 75(2): 105–108.
- Dovnik A, Crnobrnja B, Zegura B, et al. Incidence of positive peritoneal cytology in patients with endometrial carcinoma after hysteroscopy vs. dilatation and curettage. Radiol Oncol. 2017; 51(1): 88–93.
- Chen J, Clark LH, Kong WM, et al. Does hysteroscopy worsen prognosis in women with type II endometrial carcinoma? PLoS One. 2017; 12(3): e0174226.
