@article {Larish1513, author = {Alyssa Larish and Amanika Kumar and Amy Weaver and Andrea Mariani}, title = {Impact of hysteroscopy on course of disease in high-risk endometrial carcinoma}, volume = {30}, number = {10}, pages = {1513--1519}, year = {2020}, doi = {10.1136/ijgc-2020-001627}, publisher = {BMJ Specialist Journals}, 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.}, issn = {1048-891X}, URL = {https://ijgc.bmj.com/content/30/10/1513}, eprint = {https://ijgc.bmj.com/content/30/10/1513.full.pdf}, journal = {International Journal of Gynecologic Cancer} }