IMPACT OF HYSTEROSCOPY IN THE DIAGNOSIS OF UTERINE CANCER

B.J. Dulaney, M.S. Shahin, K.K. Austin, P. Hanjani

Abington Hospital, Abington, PA

OBJECTIVE: To evaluate the impact of hysteroscopy in conjunction with dilation and curettage in the diagnosis of uterine cancer and to evaluate patterns of care related to the workup of uterine cancer in a community hospital.

MATERIALS AND METHODS: A retrospective chart review was performed of two hundred sixty-eight patients with uterine cancer between 1996 and 2000. Demographic patterns evaluated were age, gravity, parity, tobacco use, and medical co-morbidities.

RESULTS: Uterine cancer was diagnosed by five methods (endometrial pipelle, dilation and curettage, ultrasound, hysteroscopy, and pap smear). Histology in our population revealed endometrioid (77%), adenosquamous (7%), serous (9%), sarcoma (3%), MMMT (2%), and clear cell (2%) carcinomas.  Fifty-three percent of our patients were diagnosed with cancer by office endometrial pipelle.  Two-thirds of all pipelles performed were diagnostic for uterine cancer.  Twenty percent (29/142) of patients with uterine cancer diagnosed by endometrial pipelle underwent a subsequent dilation and curettage.  Fifty-six percent of our patients underwent a dilation and curettage; hysteroscopy was performed in conjunction with dilation and curettage in twenty-eight patients.  In comparing patients with dilation and curettage with and without hysteroscopy, no statistical significance was found for stage (p=0.87), washings (p=0.90), lymph node status (p=0.41), or lymphovascular space invasion (p=0.06).  However, we found that patients who underwent hysteroscopy were 2.35 times more likely to have lymphovascular space invasion noted on final pathology. 

CONCLUSIONS: Endometrial pipelle is an adequate method to diagnose uterine cancer.  Hysteroscopy in conjunction with dilation and curettage, though not statistically significant, appears to increase the risk of lymphovascular space invasion and thus may be clinically significant in patients being evaluated with uterine cancer.

Key Words: hysteroscopy, uterine cancer 

Disclsoure – Nothing to disclose.