The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Guangxi Medical University, Nanning, Guangxi, China.
BMJ Open. 2024 Nov 1;14(10):e087582. doi: 10.1136/bmjopen-2024-087582.
The goal of this study is to evaluate the safety of diagnostic hysteroscopy (HSC) in type II endometrial cancer (EC).
We searched PubMed, the Cochrane Library and the Chinese Medical Journal Full-Text Database until December 2023. Eligible trials were all cohort studies in which patients were allocated to diagnostic HSC group or dilation and curettage (D&C) group. Quality assessments of eligible studies were performed using the Newcastle-Ottawa scales. Risk ratios (RRs) with 95% CIs were calculated as a measure of effects.
Three trials were included in our analysis, which were all retrospective cohort studies. 696 patients with histologically proven type II EC were allocated to HSC or D&C before surgery. 257 patients underwent preoperative HSC, and 439 patients underwent D&C. The positive peritoneal cytology rate did not statistically differ between the groups (RR, 1.9; 95% CI, 1.00 to 3.61; p=0.05). There was no significant difference in the incidence of International Federation of Gynecology and Obstetrics (FIGO) stage between the HSC and D&C groups (stage I/II: RR, 1.08; 95% CI, 0.95 to 1.24; p=0.25; stage III/IV: RR, 0.82; 95% CI, 0.62 to 1.09; p=0.18). There was no significant difference in recurrence between the HSC and D&C groups (RR, 0.92; 95% CI, 0.66 to 1.32; p=0.66); the heterogeneity of the two included studies was acceptable (p=0.54, I=0%).
Preoperative HSC in patients with type II EC does not increase the risk for cancer cell dissemination within the peritoneal cavity. Preoperative HSC does not progress the FIGO staging in patients with type II EC and does not increase the risk of tumour recurrence. There is no reason to avoid HSC for the diagnosis of type II EC currently. However, type II tumours generally are less well differentiated and have poorer prognoses than type I tumours. More prospective and adequately powered trials are required to clarify whether preoperative HSC in patients with type II EC is safe.
本研究旨在评估诊断性宫腔镜检查（HSC）在 II 型子宫内膜癌（EC）中的安全性。
我们检索了 PubMed、Cochrane 图书馆和中国医学期刊全文数据库，检索截至 2023 年 12 月。合格的试验均为将患者分配到诊断性 HSC 组或扩张刮宫术（D&C）组的队列研究。使用纽卡斯尔-渥太华量表对合格研究进行质量评估。风险比（RR）及其 95%置信区间（CI）用于评估效应。
我们的分析纳入了三项试验，均为回顾性队列研究。696 例经组织学证实的 II 型 EC 患者在术前被分配至 HSC 或 D&C。257 例患者接受术前 HSC，439 例患者接受 D&C。两组间腹膜细胞学阳性率无统计学差异（RR，1.9；95%CI，1.00 至 3.61；p=0.05）。HSC 组与 D&C 组的国际妇产科联合会（FIGO）分期无显著差异（I/II 期：RR，1.08；95%CI，0.95 至 1.24；p=0.25；III/IV 期：RR，0.82；95%CI，0.62 至 1.09；p=0.18）。HSC 组与 D&C 组间复发无显著差异（RR，0.92；95%CI，0.66 至 1.32；p=0.66）；两项纳入研究的异质性可接受（p=0.54，I=0%）。
对于 II 型 EC 患者，术前 HSC 不会增加腹腔内癌细胞播散的风险。术前 HSC 不会影响 II 型 EC 患者的 FIGO 分期，也不会增加肿瘤复发的风险。目前没有理由避免对 II 型 EC 进行 HSC 诊断。然而，与 I 型肿瘤相比，II 型肿瘤通常分化较差，预后较差。需要更多前瞻性和充分有力的试验来阐明 II 型 EC 患者术前 HSC 是否安全。
