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Controversy on Positive Peritoneal Cytology of Endometrial Carcinoma. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1906769. [PMID: 35401781 PMCID: PMC8993566 DOI: 10.1155/2022/1906769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/04/2022] [Indexed: 12/24/2022]
Abstract
Endometrial carcinoma (EC) is one of the most common gynecological malignancies. Its incidence rate has been increasing year by year. The prognostic factors and treatment strategies of EC have aroused wide concern. The effects of peritoneal cytology on the prognosis and treatment of EC remain controversial. Some factors, such as differentiation degree, muscle invasion, and tumor size, are related to positive peritoneal cytology. Hysteroscopy is commonly used in the diagnosis and treatment of endometrial cancer, but hysteroscopic surgery may cause the tumor to spread into the abdominal cavity, resulting in positive peritoneal cytology. In this review, we discuss the factors related to positive peritoneal cytology and the influence of positive peritoneal cytology on the prognosis of endometrial cancer. Suspicious positive peritoneal cytology may be an independent risk factor for endometrial cancer. The positive rate of peritoneal tumor cells in type II endometrial cancer is higher than other cells and is an independent risk factor for type II endometrial cancer. We also discuss the effects of peritoneal cytology on treatment decisions. Aggressive treatments seem to be more beneficial for patients with positive ascites cytology, but there is a lack of large-scale prospective clinical studies on their effectiveness and safety. The application of peritoneal cytology for endometrial cancer has been decreased in recent years. We believe that peritoneal cytology is necessary for this type of cancer. However, more studies on peritoneal cytology in endometrial cancer should be carried out.
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Carugno J, Wong A. Fertility-sparing approach for endometrial cancer: the role of office hysteroscopy. MINIM INVASIV THER 2021; 30:296-303. [PMID: 34292797 DOI: 10.1080/13645706.2021.1949353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Endometrial cancer is the most common gynecologic malignancy in developed countries, with increasing incidence among younger, nulliparous patients. These epidemiological shifts are attributed to increasing rates of obesity, in combination with delayed childbearing. This highlights a need for fertility-sparing options for individuals who wish to delay standard surgical management with hysterectomy, bilateral salpingoophorectomy, and assessment of pelvic/para-aortic lymph nodes. Careful consideration should be taken to select which patients are suitable candidates for fertility-sparing methods. Typically, these are patients found to have FIGO grade 1 tumors of the endometrioid subtype without myometrial invasion. Currently, conservative treatment options include the use of oral progestins and levonorgestrel-releasing intrauterine devices, with an emerging role for hysteroscopy for direct visualization of the uterine cavity, targeted tissue sampling, and tumor resection. This paper aims to highlight the role of office hysteroscopy for diagnosis, hysteroscopic tumor resection, and follow-up in suitable endometrial cancer patients who wish to preserve their uterus until childbearing is complete.
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Affiliation(s)
- José Carugno
- Minimally Invasive Gynecology Division, Department of Obstetrics, Gynecology and Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Adriana Wong
- Department of Obstetrics and Gynecology, University of California Davis Medical Center, Sacramento, CA, USA
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Kelly RA, Contos GT, Walker CA, Ayoola-Adeola M, Kim S, Winer IS. Hysteroscopic Morcellation in Endometrial Cancer Diagnosis: Increased Risk? J Minim Invasive Gynecol 2021; 28:1625-1632. [PMID: 33571678 DOI: 10.1016/j.jmig.2021.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
STUDY OBJECTIVE Operative hysteroscopy requires elevated intrauterine pressures, which could lead to the spread of malignant cells into the peritoneal cavity. Currently, there is a paucity of data analyzing clinical outcomes in endometrial cancer after hysteroscopic morcellation with newer equipment. In this study, we sought to determine whether there are increased rates of positive peritoneal cytology, lymphovascular space invasion, or surgical upstaging in patients undergoing hysteroscopic morcellation compared with alternative endometrial biopsy methods. DESIGN A retrospective chart review of patients from 2013-2018 was performed. The exclusion criteria included biopsy at outside institution, stage IV endometrial cancer known before biopsy, and missing data regarding biopsy method and histology. Peritoneal cytology results, lymphovascular space invasion, and surgical staging were compared by method of biopsy and histology using chi-square and Kruskal-Wallis tests. SETTING The patients included in this study were accrued from the Karmanos Cancer Insittute in Detroit, Michigan. PATIENTS A total of 289 patients met the inclusion criteria: 184 patients were classified as low-grade (Fédération Internationale de Gynécologie et d'Obstétrique grades 1 and 2) and 105 as high-grade (Fédération Internationale de Gynécologie et d'Obstétrique grade 3, serous, clear cell, and carcinosarcoma) endometrial cancer. INTERVENTIONS Fifty-three patients (18%) underwent hysteroscopy with morcellation. Alternative biopsy methods included hysteroscopy without morcellation, n = 81 (28%); endometrial biopsy, n = 112 (38.7%); and dilation and curettage, n = 43 (15%). MEASUREMENTS AND MAIN RESULTS Positive peritoneal cytology was noted in 34 cases (12%) and negative cytology in 165 (57%). Cytology was not performed in 90 cases (31%). When comparing outcomes by histologic subtypes, no difference was seen in peritoneal cytology (p = .704 and .727 for low grade and high grade, respectively), stage (p = .773 and .053 for low grade and high grade, respectively) or lymphovascular space invasion (p = .400 and .142 for low grade and high grade, respectively). CONCLUSION Our study demonstrates that hysteroscopy with morcellation is a safe diagnostic method for low- and high-grade endometrial pathologic conditions and does not lead to increased dissemination of malignant cells, lymphovascular space invasion, or upstaging of patients.
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Affiliation(s)
- Rebeca A Kelly
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine (Drs. Kelly, Contos, Walker, Ayoola-Adeola), Detroit, Michigan; Biostatistics Core, Department of Oncology, Wayne State University School of Medicine and Karmanos Cancer Institute, (Dr. Kim), Detroit, Michigan; Division of Gynecologic Oncology, Department of Oncology (Dr. Winer), Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, Michigan
| | - George T Contos
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine (Drs. Kelly, Contos, Walker, Ayoola-Adeola), Detroit, Michigan; Biostatistics Core, Department of Oncology, Wayne State University School of Medicine and Karmanos Cancer Institute, (Dr. Kim), Detroit, Michigan; Division of Gynecologic Oncology, Department of Oncology (Dr. Winer), Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, Michigan
| | - Christopher A Walker
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine (Drs. Kelly, Contos, Walker, Ayoola-Adeola), Detroit, Michigan; Biostatistics Core, Department of Oncology, Wayne State University School of Medicine and Karmanos Cancer Institute, (Dr. Kim), Detroit, Michigan; Division of Gynecologic Oncology, Department of Oncology (Dr. Winer), Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, Michigan
| | - Martins Ayoola-Adeola
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine (Drs. Kelly, Contos, Walker, Ayoola-Adeola), Detroit, Michigan; Biostatistics Core, Department of Oncology, Wayne State University School of Medicine and Karmanos Cancer Institute, (Dr. Kim), Detroit, Michigan; Division of Gynecologic Oncology, Department of Oncology (Dr. Winer), Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, Michigan
| | - Seongho Kim
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine (Drs. Kelly, Contos, Walker, Ayoola-Adeola), Detroit, Michigan; Biostatistics Core, Department of Oncology, Wayne State University School of Medicine and Karmanos Cancer Institute, (Dr. Kim), Detroit, Michigan; Division of Gynecologic Oncology, Department of Oncology (Dr. Winer), Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, Michigan
| | - Ira S Winer
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine (Drs. Kelly, Contos, Walker, Ayoola-Adeola), Detroit, Michigan; Biostatistics Core, Department of Oncology, Wayne State University School of Medicine and Karmanos Cancer Institute, (Dr. Kim), Detroit, Michigan; Division of Gynecologic Oncology, Department of Oncology (Dr. Winer), Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, Michigan.
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Simonsen M, Mantoan H, Faloppa CC, Kumagai LY, Badiglian Filho L, Machado AG, Tayfour NM, Baiocchi G. Residual Disease after Operative Hysteroscopy in Patients with Endometrioid Endometrial Cancer Associated with Polyps. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:35-40. [PMID: 33513634 PMCID: PMC10183887 DOI: 10.1055/s-0040-1719145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To evaluate the presence of residual disease in the uterine specimen after hysteroscopic polypectomy or polyp biopsy in patients with endometrioid endometrial cancer (EC). METHODS We analyzed a series of 104 patients (92 cases from the Hospital AC Camargo and 12 from the Hospital do Servidor Público Estadual de São Paulo) with polyps that were diagnosed by hysteroscopy, showing endometrioid EC associated with the polyp or in the final pathological specimen. Patients underwent a surgical approach for endometrial cancer from January 2002 to January 2017. Their clinical and pathological data were retrospectively retrieved from the medical records. RESULTS In 78 cases (75%), the polyp had EC, and in 40 (38.5%), it was restricted to the polyp, without endometrial involvement. The pathologic stage was IA in 96 cases (92.3%) and 90 (86.5%) had histologic grade 1 or 2. In 18 cases (17.3%), there was no residual disease in the final uterine specimen, but only in 9 of them the hysteroscopy suggested that the tumor was restricted to the polyp. In 5 cases (4.8%) from the group without disease outside of the polyp during hysteroscopy, myometrial invasion was noted in the final uterine specimen. This finding suggests the possibility of disease extrapolation through the base of the polyp. CONCLUSION Patients with endometrioid EC associated with polyps may have the tumor completely removed during hysteroscopy, but the variables shown in the present study could not safely predict which patient would have no residual disease.
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Affiliation(s)
- Marcelo Simonsen
- Department of Gynecologic Oncology, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
| | - Henrique Mantoan
- Department of Gynecologic Oncology, Hospital AC Camargo, São Paulo, SP, Brazil
| | | | | | | | - Andrea Guerreiro Machado
- Department of Gynecologic Oncology, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
| | - Najla Mohamed Tayfour
- Department of Gynecologic Oncology, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
| | - Glauco Baiocchi
- Department of Gynecologic Oncology, Hospital AC Camargo, São Paulo, SP, Brazil
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Histopathology and Clinical Outcomes of 151 Women with Postmenopausal Bleeding Treated with Resectoscopic Surgery. J Minim Invasive Gynecol 2019; 27:763-773. [PMID: 31202823 DOI: 10.1016/j.jmig.2019.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/22/2019] [Accepted: 06/05/2019] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE Because postmenopausal bleeding (PMB) is associated with up to 10% of endometrial neoplasia and office endometrial sampling fails in approximately 10% and is inadequate in 30% of cases, the objective was to determine the role of hysteroscopic endometrial resection (HER) for the diagnosis and treatment of women with PMB. DESIGN A retrospective cohort. SETTING A university-affiliated teaching hospital. PATIENTS One hundred fifty-one women with PMB (September 1990-December 2010). INTERVENTION HER in the operating room. MEASUREMENTS AND MAIN RESULTS The median (range) age and body mass index were 58 (50-87) years and 29 (21-52) kg/m2, respectively. Office endometrial biopsy failed in 30 (19.8%), was inadequate in 20 (13.2%), identified nonatypical endometrial hyperplasia (NAH) in 21 (14%), atypical hyperplasia (AH) in 4 (2.6%), and endometrial cancer (EC) in 2 (1.3%) women. HER in 151 women identified 7 new cases of AH (3 from failed/inadequate office biopsy and 4 from NAH) and 9 EC (5 from failed/inadequate office biopsy, 1 from proliferative endometrium, 2 from NAH, and 1 from AH). All 27 women with NAH were treated by HER alone. Of 8 women with AH, 6 were treated with HER and 2 with hysterectomy; no residual endometrium was found in hysterectomy specimens. Of the 11 women with EC, 2 refused hysterectomy and are well 10 and 15 years after HER. Hysterectomy was performed for 9 of 11 EC cases, 2 of 8 AH cases, and 1 for abnormal uterine bleeding. Six women had repeat HER for persistent abnormal uterine bleeding, and 10 were lost to follow-up. At a median follow-up of 11.5 years (range, 7-20 years), 132 (12 hysterectomies + 10 lost) of 151 (87.4%) women were satisfied with no further bleeding. CONCLUSION In women with PMB, hysteroscopic endometrial resection concomitantly with resection of intrauterine pathology by experienced surgeons is feasible, safe, and effective for diagnosis in all cases and treatment of the majority of intrauterine pathology including NAH and selected cases of AH and EC.
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Casadio P, Guasina F, Talamo MR, Paradisi R, Morra C, Magnarelli G, Seracchioli R. Conservative hysteroscopic treatment of stage I well differentiated endometrial cancer in patients with high surgical risk: a pilot study. J Gynecol Oncol 2019; 30:e62. [PMID: 31074243 PMCID: PMC6543116 DOI: 10.3802/jgo.2019.30.e62] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/24/2019] [Accepted: 02/04/2019] [Indexed: 12/13/2022] Open
Abstract
Objective To report hysteroscopic treatment combined with levonorgestrel-releasing intrauterine device (LNG-IUD) to treat women with early well differentiated endometrial cancer (EC) at high surgical risk. Methods Nine women diagnosed with stage IA, grade 1 endometrioid EC which was contraindicated or refused standard treatment with external beam radiation therapy with or without brachytherapy were enrolled in our prospective study. Endo-myometrial hysteroscopic resection of the whole uterine cavity and the placement of LNG-IUD for 5 years was performed. Response rate, perioperative complications, and recurrence of disease were evaluated. Results None had intra or post-operative complications and all were discharged no later than the third day of hospitalization. After 6 months from surgery, all the women showed a complete regression of the lesion. All the women completed the 5 years follow-up and in no case was detected sign of recurrence. Two women died for causes unrelated to the tumor or the ongoing therapy. Conclusion The alternative treatment with endo-myometrial hysteroscopic resection and LNG-IUD in women with stage IA, grade 1 endometrioid EC showed initial encouraging outcomes in terms of effectiveness and safety.
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Affiliation(s)
- Paolo Casadio
- Department of Obstetrics, Gynecology and Reproductive Biology, DIMEC, S.Orsola Hospital, University Alma Mater Studiorum of Bologna, Bologna, Italy
| | - Francesca Guasina
- Department of Gynecology and Obstetrics, Santa Chiara Regional Hospital, Trento, Italy
| | - Maria Rita Talamo
- Department of Obstetrics, Gynecology and Reproductive Biology, DIMEC, S.Orsola Hospital, University Alma Mater Studiorum of Bologna, Bologna, Italy.
| | - Roberto Paradisi
- Department of Obstetrics, Gynecology and Reproductive Biology, DIMEC, S.Orsola Hospital, University Alma Mater Studiorum of Bologna, Bologna, Italy
| | - Ciro Morra
- Department of Obstetrics, Gynecology and Reproductive Biology, DIMEC, S.Orsola Hospital, University Alma Mater Studiorum of Bologna, Bologna, Italy
| | - Giulia Magnarelli
- Department of Obstetrics, Gynecology and Reproductive Biology, DIMEC, S.Orsola Hospital, University Alma Mater Studiorum of Bologna, Bologna, Italy
| | - Renato Seracchioli
- Department of Obstetrics, Gynecology and Reproductive Biology, DIMEC, S.Orsola Hospital, University Alma Mater Studiorum of Bologna, Bologna, Italy
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Elyashiv O, Sagiv R, Kerner R, Keidar R, Menczer J, Levy T. Hysterscopic Resection of Premalignant and Malignant Endometrial Polyps: Is it a Safe Alternative to Hysterectomy? J Minim Invasive Gynecol 2017; 24:1200-1203. [DOI: 10.1016/j.jmig.2017.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/01/2017] [Accepted: 08/02/2017] [Indexed: 12/24/2022]
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Chen J, Clark LH, Kong WM, Yan Z, Han C, Zhao H, Liu TT, Zhang TQ, Song D, Jiao SM, Zhou C. Does hysteroscopy worsen prognosis in women with type II endometrial carcinoma? PLoS One 2017; 12:e0174226. [PMID: 28334032 PMCID: PMC5363864 DOI: 10.1371/journal.pone.0174226] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 03/05/2017] [Indexed: 01/07/2023] Open
Abstract
Background Prior studies evaluating the impact of hysteroscopy on outcomes in endometrial cancer have predominantly evaluated type I tumors. We sought to evaluate whether hysteroscopy worsens prognosis in type II endometrial cancer. Methods A retrospective cohort analysis of 140 patients from two institutions with type II endometrial cancer was performed. Women who underwent either diagnostic hysteroscopy (HSC) or dilation and curettage (D&C) for cancer diagnosis from June 2001 until June 2010 were included. The clinical and pathologic characteristics, including peritoneal cytology results were reviewed. The primary endpoint was disease-specific survival (DSS). The exposure of interest was hysteroscopy. Survival curves were projected using the Kaplan-Meier method and compared using the log-rank test. Results There was no difference in age, histology, stage, depth of myometrial invasion, adnexal involvement, or nodal metastasis between HSC and D&C patients. Positive cytology was found in 16/54 (30%) patients following HSC and in 10/86 (12%) following D&C (p = 0.008). Fourteen patients with stage I and II disease had positive peritoneal cytology, with 11/40 (27.5%) patients in the HSC group and 3/59 (5%) patients in the D&C group(p = 0.002). Median DSS was clinically different for the HSC and D&C groups, but statistical significance was not reached (53 versus 63.5 months, p = 0.34). For stage I and II patients, 18/99 (18%) were dead of EC, with a median DSS of 60 months for HSC and 71 months for D&C (p = 0.82). Overall 46 (33%) patients developed a recurrence, with 18/54 (33%) in the HSC group compared to 28/86 (32%) in the D&C group (p = 0.92). There was no difference in recurrence location between groups. Conclusions Diagnostic hysteroscopy significantly increased the rate of positive peritoneal cytology at the time of surgical staging in this cohort of patients with type II EC. However, we were unable to detect a difference in prognosis as measured by DSS.
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Affiliation(s)
- Jiao Chen
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Leslie H. Clark
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Wei-Min Kong
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- * E-mail: (WMK); (CZ)
| | - Zhen Yan
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Chao Han
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Hui Zhao
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Ting-Ting Liu
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Tong-Qing Zhang
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Dan Song
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Si-Meng Jiao
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Chunxiao Zhou
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina, United States of America
- * E-mail: (WMK); (CZ)
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Vilos GA, Oraif A, Vilos AG, Ettler H, Edris F, Abu-Rafea B. Long-term clinical outcomes following resectoscopic endometrial ablation of non-atypical endometrial hyperplasia in women with abnormal uterine bleeding. J Minim Invasive Gynecol 2014; 22:66-77. [PMID: 25048567 DOI: 10.1016/j.jmig.2014.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 07/08/2014] [Accepted: 07/09/2014] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To determine the feasibility, efficacy, and long-term clinical outcomes of resectoscopic endometrial ablation as primary treatment of simple endometrial hyperplasia (SH) and complex endometrial hyperplasia (CH) without atypia in women with abnormal uterine bleeding (AUB). DESIGN Prospective follow-up study (Canadian Task Force classification II-2). SETTING Teaching hospital. PATIENTS One hundred sixty-one women with hyperplasia, either SH (n = 107) or CH (n = 54). INTERVENTIONS From January 1990 through December 2012, one of us performed 4729 primary resectoscopic endometrial ablation procedures in women with AUB. This group included 161 women with endometrial hyperplasia, identified either at office biopsy (n = 62) or incidentally during routine hysteroscopic endometrial ablation (n = 99). Endometrial tissue obtained at dilation and curettage and/or resected during resectoscopic surgery enabled identification of atypical hyperplasia in 6 patients (4 CH, 2 SH) and 1 patient with adenosarcoma. One patient with atypical CH and the patient with adenosarcoma underwent hysterectomy. The remaining 159 women, including 5 with atypical hyperplasia (3 CH, 2 SH), underwent resectoscopic endometrial ablation (102 SH, 52 CH) as primary treatment. Patient median age was 50 years (range, 30-87 years), and body mass index was 32 (range, 17-59). Comorbidities included hypertension in 25 patients, diabetes in 14, cerebrovascular disease in 3, cardiovascular disease in 7, and hypothyroidism in 8. Office biopsy demonstrated proliferative endometrium in 68 patients, SH in 43, CH in 19, and inadequate findings in 13. In 18 women, we were unable to perform biopsy because of cervical stenosis, morbid obesity, or patient intolerance. Endometrium was resected in 120 patients, electrocoagulated in 34, and a combination of procedures in 5, using a 9-mm (26F) resectoscope, 1.5% glycine, and 120W power. Patients were followed up annually. Three patients were lost to follow-up, and 1 died of an unrelated cause 5 years after surgery. MEASUREMENTS AND MAIN RESULTS One uterine perforation occurred, which required no additional treatment. After endometrial ablation, SH was identified in 70 patients, and CH in 35 patients. At a median follow-up of 7 years (range, 1.5-18), 12 patients underwent hysterectomy to treat persistent bleeding (n = 6), benign ovarian cyst (n = 2), pelvic organ prolapse (n = 1), chronic pelvic pain (n = 2), or myomas (n = 1). Uterine histopathology in 11 patients demonstrated no residual endometrial hyperplasia. We were unable to obtain a pathology report for 1 patient. The remaining 138 women were satisfied with the treatment, with no further bleeding or pain in 132 (95.7%). Six patients (4.3%) had monthly spotting. CONCLUSION When performed by surgeons experienced in hysteroscopy, resectoscopic endometrial ablation is feasible, safe, and effective for treatment of SH and CH without atypia in women with AUB.
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Affiliation(s)
- George A Vilos
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Western University, London, Ontario, Canada.
| | - Ayman Oraif
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Western University, London, Ontario, Canada
| | - Angelos G Vilos
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Western University, London, Ontario, Canada
| | - Helen Ettler
- Department of Pathology, Western University, London, Ontario, Canada
| | - Fawaz Edris
- Department of Obstetrics and Gynecology, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Basim Abu-Rafea
- Division of Reproductive Endocrinology and Infertility, Dalhousie University, Halifax, Nova Scotia, Canada
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Effect of hysteroscopy on the peritoneal dissemination of endometrial cancer cells: a meta-analysis. Fertil Steril 2011; 96:957-61. [DOI: 10.1016/j.fertnstert.2011.07.1146] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 07/28/2011] [Accepted: 07/28/2011] [Indexed: 11/23/2022]
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Erkanli S, Ayhan A. Fertility-Sparing Therapy in Young Women With Endometrial Cancer. Int J Gynecol Cancer 2010; 20:1170-87. [DOI: 10.1111/igc.0b013e3181e94f5a] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Miscellaneous Uterine Malignant Neoplasms Detected during Hysteroscopic Surgery. J Minim Invasive Gynecol 2009; 16:318-25. [DOI: 10.1016/j.jmig.2009.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 02/03/2009] [Accepted: 02/05/2009] [Indexed: 11/21/2022]
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Prise en charge des métrorragies post-ménopausiques. IMAGERIE DE LA FEMME 2007. [DOI: 10.1016/s1776-9817(07)78172-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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