Diagnostic performances of hysteroscopy in post-remission surveillance of patients treated conservatively for endometrial cancer and atypical hyperplasia: a cohort study.

OBJECTIVE

Hysteroscopy is commonly used for diagnosing benign endometrial conditions, but its diagnostic performance in malignancies post-treatment surveillance has not been evaluated. This study evaluated the correlation between hysteroscopic appearance and histological outcomes in patients in remission after conservative treatment for atypical hyperplasia (AH) or early-stage endometrial cancer (EC).

STUDY DESIGN

Multicenter retrospective cohort study utilizing data from the French national register of fertility-sparing management for AH/EC (PREFERE database) from May 2015 to December 2020. The study included patients over 18 years with a prior diagnosis of AH or stage IA1 EC, who achieved remission following progestin-based fertility-sparing treatment. Hysteroscopy and endometrial biopsy were performed for post-remission surveillance. Hysteroscopic appearances were categorized, and the corresponding histopathological results were reviewed as the gold standard for detecting recurrence or remission. Non-suspicious findings (normal or atrophic) and suspicious findings (thickened, polypoid, polyp-like or atypical vessels presence) in hysteroscopy were evaluated for concordance with biopsy results.

RESULTS

The study followed 47 patients in remission yielding in 121 hysteroscopy-biopsy pairings, of which 63 were non-suspicious. Diagnostic accuracy of hysteroscopy was 63 % (95 % CI: 54-71 %), with sensitivity of 71 % (95 % CI: 52-86 %) and specificity of 60 % (95 % CI: 49-70 %). The positive predictive value was 38 %, and the negative predictive value was 86 %. Non-suspicious hysteroscopic findings correlated better with normal histopathology, while suspicious findings were less predictive of recurrence.

CONCLUSION

The findings highlight the necessity of combining hysteroscopic findings with biopsy for reliable post-treatment monitoring in fertility-sparing management of AH/EC. Hysteroscopy alone lacks sufficient accuracy which aligns with current guidelines and underscores the importance of follow-up protocols to detect recurrence in this high-risk population. Integrating advanced imaging modalities or diagnostic tools based on artificial intelligence may enhance the accuracy of recurrence detection in this patient population.