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Impact of hysteroscopy on course of disease in high-risk endometrial carcinoma
  1. Alyssa Larish1,
  2. Amanika Kumar2,
  3. Amy Weaver1,3 and
  4. Andrea Mariani2
  1. 1 Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Gynecologic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
  3. 3 Department of Biostatistics, Mayo Clinic Minnesota, Rochester, New York, USA
  1. Correspondence to Dr Alyssa Larish, Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA; alyssalarish{at}gmail.com

Abstract

Objective Previous studies have investigated the impact of preoperative hysteroscopy on the staging and survival of predominantly grade 1 endometrial cancers. We sought to evaluate the effect of hysteroscopy on the peritoneal spread of tumor cells and disease course in a large series of patients with high-risk endometrial cancer.

Methods Patients who underwent hysterectomy for grade 3 endometrial carcinoma on final surgical pathology at the Mayo Clinic in Rochester, MN between January 2009 to June 2016 were included, noting hysteroscopy within 6 months from surgery. Intra-peritoneal disease was defined as any positive cytology OR adnexal invasion OR stage IV. The presence of intra-peritoneal disease OR peritoneal recurrence within 2 years from surgery was defined as peritoneal dissemination. Cox proportional hazards models were fit to evaluate associations between hysteroscopy exposure and progression within 5 years following surgery.

Results Among 831 patients, 133 underwent hysteroscopy. There was no difference in age, body mass index, ASA ≥3, or serous histology between patients who did or did not undergo hysteroscopy. Advanced stage disease (III/IV) was less common among patients who underwent hysteroscopy (30.1% vs 43.8%, P=0.003). No difference was observed between those with vs without hysteroscopy in the rate of positive cytology (22.0% vs 29.7%, P=0.09), stage IV (16.5% vs 21.9%, P=0.16), intra-peritoneal disease (28.6% vs 36.1%, P=0.09), or peritoneal dissemination (30.8% vs 39.3%, P=0.06). On stratifying by stage, hysteroscopy did not increase the risk of progression (HR 1.06, 95% CI 0.59 to 1.92 for stage I/II; HR 0.96, 95% CI 0.62 to 1.48 for stage III/IV).

Conclusion In this retrospective study of grade 3 endometrial cancer, we did not observe any significant association between pre-operative hysteroscopy and the incidence of positive cytology, peritoneal disease, peritoneal dissemination, or cancer progression.

  • endometrial neoplasms
  • hysteroscopes
  • surgical procedures
  • operative
  • neoplasm recurrence
  • local

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Footnotes

  • Contributors All authors contributed meaningfully to the conception, design, data interpretation, manuscript preparation, and revision of this study.

  • 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.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are available upon reasonable request. Deidentified participant data may be obtained after appropriate data use agreements between institutions.