Department of Obstetrics and Gynecology, University of Thessalia, Larissa, Greece.
Int J Gynecol Cancer. 2010 Feb;20(2):261-7. doi: 10.1111/igc.0b013e3181ca2290.
Hysteroscopy is a diagnostic procedure with a high accuracy in diagnosing endometrial cancer. Because of the increase of intrauterine pressure during distention media inflation, several retrospective studies postulated that it may result in cancer cell dissemination within the peritoneal cavity through the fallopian tubes. We therefore set to estimate whether hysteroscopy increases the risk for intraperitoneal cancer cell dissemination in patients with endometrial cancer and the risk of disease upstaging in patients with clinically early-stage disease.
We searched the PubMed, the ISI Web of Science, and the Cochrane Library through July 2009. Eligible trials were all controlled clinical trials in which patients were allocated to hysteroscopy (alone or after other diagnostic procedure, eg, dilation and curettage and biopsy) versus any other diagnostic procedure except hysteroscopy or no procedure before surgery for endometrial carcinoma.
Nine trials were included in our analysis. One thousand fifteen patients with histologically proven endometrial carcinoma were allocated to hysteroscopy or no hysteroscopy before surgery. Hysteroscopy resulted in a significantly higher rate of malignant peritoneal cytology (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.13-2.79; P = 0.013) and significantly higher disease upstaging owing solely to the presence of malignant cells in the peritoneal cavity (OR, 2.61; 95% CI, 1.47-4.63; P = 0.001) compared with no hysteroscopy. When isotonic sodium chloride was used as distention medium, hysteroscopy resulted in a statistically significant higher rate of malignant peritoneal cytology (OR, 2.89; 95% CI, 1.48-5.64; P = 0.002), whereas a nonsignificant trend for higher malignant cells was observed in patients allocated to the hysteroscopy group (OR, 3.23; 95% CI, 0.94-11.09; P = 0.062) when inflated media pressure reached or exceeded 100 mm Hg.
Hysteroscopy in patients with endometrial cancer hints a risk for cancer cell dissemination within the peritoneal cavity. Prospective and sufficiently powered trials are needed to clarify whether the risk of cancer cell spreading is correlated with worse prognosis.
宫腔镜检查在诊断子宫内膜癌方面具有较高的准确性。由于在膨胀介质充气过程中子宫内压力增加，一些回顾性研究推测，它可能通过输卵管导致癌细胞在腹腔内扩散。因此，我们旨在评估宫腔镜检查是否会增加子宫内膜癌患者腹腔内癌细胞扩散的风险，以及是否会增加临床早期疾病患者的疾病分期。
我们通过 2009 年 7 月之前的 PubMed、ISI Web of Science 和 Cochrane 图书馆进行了搜索。符合条件的试验均为患者被分配到宫腔镜检查（单独或在其他诊断程序如扩张和刮宫及活检后）与任何其他诊断程序（除了宫腔镜检查或术前无程序）的对照临床试验，用于治疗子宫内膜癌。
我们的分析纳入了 9 项试验。1015 例经组织学证实的子宫内膜癌患者被分配到宫腔镜检查或术前无宫腔镜检查。与无宫腔镜检查相比，宫腔镜检查导致恶性腹腔细胞学的发生率显著升高（比值比 [OR]，1.78；95%置信区间 [CI]，1.13-2.79；P = 0.013），且由于腹腔内存在恶性细胞而导致疾病分期显著升高（OR，2.61；95% CI，1.47-4.63；P = 0.001）。当使用等渗氯化钠作为膨胀介质时，宫腔镜检查导致恶性腹腔细胞学的发生率显著升高（OR，2.89；95% CI，1.48-5.64；P = 0.002），而当膨胀介质压力达到或超过 100mmHg 时，分配到宫腔镜检查组的患者中恶性细胞的比例呈上升趋势，但无统计学意义（OR，3.23；95% CI，0.94-11.09；P = 0.062）。
在子宫内膜癌患者中进行宫腔镜检查提示存在癌细胞在腹腔内扩散的风险。需要进行前瞻性和充分有效的试验，以明确癌细胞扩散的风险是否与预后更差相关。
