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Original research
Oncological safety of hysteroscopy in endometrial cancer
  1. Raquel Quintana-Bertó1,
  2. Pablo Padilla-Iserte1,
  3. Antonio Gil-Moreno2,
  4. Reyes Oliver-Pérez3,
  5. Pluvio J. Coronado4,
  6. María Belén Martín-Salamanca5,
  7. Manuel Pantoja-Garrido6,
  8. Cristina Lorenzo7,
  9. Eduardo Cazorla8,
  10. Juan Gilabert-Estellés9,
  11. Lourdes Sánchez10,
  12. Fernando Roldán-Rivas11,
  13. Berta Díaz-Feijoo12,
  14. José Ramón Rodríguez-Hernández13,
  15. Josefina Marcos-Sanmartin14,
  16. Juan Carlos Muruzábal15,
  17. Antonio Cañada16 and
  18. Santiago Domingo1
  1. 1 Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, València, Spain
  2. 2 Gynecologic Oncology Unit, Gynecology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
  3. 3 Gynecologic Oncology-Unit, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute, Madrid, Spain
  4. 4 Women's Health Institute of the Hospital Clínico San Carlos, IdISSC University Complutense, Madrid, Spain
  5. 5 Gynecology Department, Hospital Universitario de Getafe, Getafe, Spain
  6. 6 Department of Gynecology and Obstetrics, University Hospital Virgen Macarena, Seville, Spain
  7. 7 Department of Obstetrics and Gynecology, Hospital Nuestra Señora de la Calendaria, Tenerife, Spain
  8. 8 Department of Obstetrics and Gynecology, Hospital Universitario de Torrevieja, Torrevieja, Spain
  9. 9 Department of Obstetrics and Gynecology, University General Hospital of València, València, Spain
  10. 10 Gynaecology and Obstetrics Department, University General Hospital of Ciudad Real, Castilla la Mancha, Spain
  11. 11 Department of Obstetrics and Gynaecology, Clinico Lozano Blesa Hospital, Zaragoza, Spain
  12. 12 Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
  13. 13 Gynaecology and Obstetrics Department, Virgen de la Arrixaca University Hospital, El Palmar, Murcia, Spain
  14. 14 Department of Obstetrics and Gynecology, Hospital General Universitari d'Alacant, Alicante, Spain
  15. 15 Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, Pamplona, Spain
  16. 16 Department of Biostatistics, Health Research Institute La Fe València Spain, Valencia, Spain
  1. Correspondence to Dr Raquel Quintana-Bertó, Department of Gynecologic Oncology, Polytechnic Hospital, València, Spain; raquelqb.25{at}gmail.com

Abstract

Objective It has been suggested that the manipulation of neoplastic tissue during hysteroscopy may lead to dissemination of tumor cells into the peritoneal cavity and worsen prognosis and overall survival. The goal of this study was to assess the oncological safety comparing hysteroscopy to Pipelle blind biopsy in the presurgical diagnosis of patients with endometrial cancer.

Methods We performed a retrospective multicentric study among patients who had received primary surgical treatment for endometrial cancer. A multivariate statistical analysis model was used to compare relapse and survival rates in patients who had been evaluated preoperatively either by hysteroscopy or Pipelle biopsy. The relapse rate, disease-free survival, and overall survival were assessed as the main outcomes. The histological type, tumor size, myometrial invasion, International Federation of Gynecology and Obstetrics (FIGO) stage, surgical approach, use of a uterine manipulator, and adjuvant treatment were also included in the analysis.

Results A total of 1731 women from 15 centers were included: 1044 in the hysteroscopy group and 687 in the Pipelle sampling group. 225 patients relapsed during the 10 year follow-up period: 139 (13.3%) in the hysteroscopy group and 86 (12.4%) in the Pipelle sampling group. There is no evidence of an association between the use of hysteroscopy as a diagnostic method and relapse rate (HR 1.24, 95% CI 0.92 to 1.66; p=0.16), lower disease-free survival (HR 1.23, 95% CI 0.92 to 1.66; p=0.15), or overall survival (HR 0.95, 95% CI 0.70 to 1.29; p=0.76).

Conclusion Hysteroscopy is a safe diagnostic method for patients with endometrial cancer with no impact on oncological outcomes when compared with sampling by Pipelle.

  • endometrial neoplasms
  • hysteroscopes
  • surgical oncology

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/ijgc-2022-003586

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Contributors Guarantors: RQ-B and PP-I. Conceptualization: RQ-B, PP-I and AC. Methodology: RQ-B, PP-I and AC. Validation: PP-I, AD y AC. Formal analysis: PP-I and AC. Investigation: RQ-B and PP-I. Resources: RQ-B, PP-I, AG-M, RO-P, PJC, MBM-S, MP-G, CL, EC, JG-E, LS, FR-R, BD-F, JRR-H, JM-S, JCM, AC and SD. Data curation: RQ-B, PP-I, AG-M, RO-P, PJC, MBM-S, MP-G, CL, EC, JG-E, LS, FR-R, BD-F, JRR-H, JM-S, JCM, AC and SD. Writing - original draft: RQ-B, PP-I and AC. Writing - review and editing: RQ-B, PP-I, AC, AG-M, PJC. Visualization: RQ-B, PP-I, AG-M, ROP, PJC, MBM-S, MP-G, CL, EC, JG-E, LS, FR-R, BD-F, JRR-H, JM-S, JCM, AC and SD. Supervision: PP-I, SD y AC. Project administration: RQ-B and PP-I.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.