Quintana-Bertó Raquel, Padilla-Iserte Pablo, Gil-Moreno Antonio, Oliver-Pérez Reyes, Coronado Pluvio J, Martín-Salamanca María Belén, Pantoja-Garrido Manuel, Lorenzo Cristina, Cazorla Eduardo, Gilabert-Estellés Juan, Sánchez Lourdes, Roldán-Rivas Fernando, Díaz-Feijoo Berta, Rodríguez-Hernández José Ramón, Marcos-Sanmartin Josefina, Muruzábal Juan Carlos, Cañada Antonio, Domingo Santiago
Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, València, Spain
Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, València, Spain.
Int J Gynecol Cancer. 2022 Nov 7;32(11):1395-1401. doi: 10.1136/ijgc-2022-003586.
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.
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.
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).
Hysteroscopy is a safe diagnostic method for patients with endometrial cancer with no impact on oncological outcomes when compared with sampling by Pipelle.
有人提出，宫腔镜检查期间对肿瘤组织的操作可能会导致肿瘤细胞播散至腹腔，从而使预后和总生存期恶化。本研究的目的是在子宫内膜癌患者的术前诊断中，比较宫腔镜检查与 Pipelle 盲刮活检的肿瘤学安全性。
我们对接受子宫内膜癌一期手术治疗的患者进行了一项回顾性多中心研究。采用多变量统计分析模型，比较术前通过宫腔镜检查或 Pipelle 活检进行评估的患者的复发率和生存率。将复发率、无病生存期和总生存期作为主要观察指标。分析还包括组织学类型、肿瘤大小、肌层浸润、国际妇产科联盟（FIGO）分期、手术方式、子宫操纵器的使用以及辅助治疗。
共纳入了来自 15 个中心的 1731 名女性：宫腔镜检查组 1044 名，Pipelle 取样组 687 名。在 10 年随访期内，225 名患者复发：宫腔镜检查组 139 名（13.3%），Pipelle 取样组 86 名（12.4%）。没有证据表明将宫腔镜检查作为诊断方法与复发率（风险比 1.24，95%置信区间 0.92 至 1.66；p = 0.16）、较低的无病生存期（风险比 1.23，95%置信区间 0.92 至 1.66；p = 0.15）或总生存期（风险比 0.95，95%置信区间 0.70 至 1.29；p = 0.76）之间存在关联。
与 Pipelle 取样相比，宫腔镜检查对子宫内膜癌患者是一种安全的诊断方法，对肿瘤学结局无影响。
