Hysteroscopy and cytology in endometrial cancer.
ABSTRACT To estimate the effect of preoperative diagnostic hysteroscopy on peritoneal cytology in patients with endometrial cancer.
A total of 256 charts were reviewed. Two cohorts were established based on diagnosis by hysteroscopy or blind endometrial sampling via either endometrial biopsy or dilatation and curettage (D&C). Malignant or suspicious peritoneal cytology was the primary outcome. Cohorts were compared using logistic regression to correct for potential confounders of stage and grade.
A total of 204 cases were diagnosed by endometrial biopsy or D&C, whereas 52 were identified by hysteroscopy. In the endometrial biopsy or D&C arm, 14 of 204 (6.9%) patients had malignant or suspicious cytology compared with 7 of 52 (13.5%) patients in the hysteroscopy arm (P = .15). After logistic regression controlling for stage and grade, the odds ratio for positive cytology after hysteroscopy was 3.88 (95% confidence interval 1.11,13.6; P = .03). Four of the 52 (7.7%) cases diagnosed by hysteroscopy were stage IIIA due to cytology alone compared with 3 of the 204 (1.4%) cases diagnosed by endometrial biopsy or D&C (P = .03).
Hysteroscopy appears to be associated with an increased rate of malignant cytology after controlling for confounders of stage and grade. Further, there appears to be an association between hysteroscopy and upstaging patients due to cytology alone.
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ABSTRACT: 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.Gynecologic Oncology 10/2007; 107(1):94-8. · 3.93 Impact Factor
Article: Management of endometrial cancer.[show abstract] [hide abstract]
ABSTRACT: Endometrial cancer is the fourth most common malignancy diagnosed in US women. Although most cases present in early stages and respond well to surgical staging with appropriately administered adjuvant radiation, the prognosis for advanced endometrial cancers is comparatively poor. Currently available treatments for advanced and recurrent metastatic endometrial cancer have significant toxicities, and are given to a population that is usually elderly with multiple other medical comorbidities. This article examines the pathogenesis of endometrial cancer as well as its diagnosis and management.Women s Health 10/2008; 4(5):479-89.
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ABSTRACT: The objective of this study was to determine if total laparoscopic hysterectomy using a uterine manipulator with an intrauterine balloon increases the risk of positive peritoneal washings in patients with endometrial cancer. Three sets of peritoneal washings were obtained during surgery from 46 women with endometrial cancer at the Center for Uterine Cancer, National Cancer Center, Korea, between May 2004 and July 2006: the first before the insertion of the uterine manipulator (premanipulator), the second after clipping the fallopian tubes and inserting the uterine manipulator (postmanipulator), and the third after the removal of the uterus through the vagina (posthysterectomy). The cytology samples were examined by the same cytopathologist for the presence of malignant cells. Two of 46 (4.3%) patients were upstaged to IIIA disease due to positive cytology conversion after the insertion of the uterine manipulator, one after the insertion of the uterine manipulator, and the other after the hysterectomy. However, during the follow-up for 3-28 months (median 18), neither of the 2 patients experienced a tumor recurrence. In conclusion, using a uterine manipulator with an intrauterine balloon during the laparoscopic surgery for endometrial cancer might be associated with positive cytologic conversion. Possible explanations are retrograde seeding of tumor cells into the peritoneal cavity, the pressure effect of the inflatable manipulator tip, and spillage of preexited tumor cells between the isthmus and the fimbriae. More effective preventive methods such as distal tubal clipping or coagulation of the fimbriae may be necessary in treating women with endometrial cancer.International Journal of Gynecological Cancer 02/2008; 18(5):1145-9. · 1.94 Impact Factor