Number of hysteroscopies and the time interval between hysteroscopy and surgery: influence on peritoneal cytology in patients with endometrial cancer.

Aim: Hysteroscopy is a routine procedure for the diagnosis of endometrial cancer (EC). Moreover, with implementation of sentinel lymph node technique, a second hysteroscopy is necessary for technetium injection before performing lymphadenectomy. As yet, no data are available showing whether the time interval between hysteroscopy and definitive surgery, or the number of preoperative hysteroscopies, have an influence on the intraperitoneal cytology results.

Patients And Methods: Data from patients with EC undergoing surgery in the years 2005-2008 at the Department of Obstetrics and Gynecology, University of Tübingen, were analyzed retrospectively. Cytological results were correlated with the number of preoperative hysteroscopies and with the time interval between hysteroscopy and surgery.

Results: In 2005-2008, a total of 196 patients with EC and known cytological results underwent surgery. Positive cytological results (C+) were obtained in 11 patients (5.6%). The rate of C+ in patients without hysteroscopy was 18.2% (n=4) and in patients after one and two hysteroscopies, 1.9% (n=2) and 7.1% (n=5), respectively (p=0.008). The rate of C+ in patients with early EC (FIGO I and II) increased after two hysteroscopies (3.1% vs. 1% after one hysteroscopy and 0% without hysteroscopy) but the difference did not reach statistical significance (p=0.513). The mean time interval between hysteroscopy and definitive surgery with cytological examination was 11.1+/-15.2 days (range 0-97 days, median=1). C+ in the group of patients with a time gap between hysteroscopy and surgery of 1 day there was in 1 case (p=0.161).

Conclusion: The finding of positive cytology results is independent from the time interval between preoperative hysteroscopy and definitive surgery. Furthermore, multiple hysteroscopies do not appear to significantly increase peritoneal tumor cell dissemination. Hysteroscopy is safe and indispensable in patients with EC.