Effect of hysteroscopy on the peritoneal dissemination of endometrial cancer cells: a meta-analysis

Objective: To determine whether preoperative hysteroscopic examination increases the risk for peritoneal dissemination of endometrial cancer cells and the effect of hysteroscopy on disease prognosis. Design: Meta-analysis. Setting: Literature search conducted via domestic and international databases for studies on preoperative hysteroscopy. Patient(s): A total of 2,944 women with endometrial cancer enrolled in selected studies. Intervention(s): Preoperative hysteroscopic examination for 1,099 patients. Main Outcome Measure(s): Rate of positive peritoneal cytology. Result(s): Of 308 studies retrieved, 19 were included in the meta-analysis. The meta-analysis demonstrated that hysteroscopy resulted in a statistically significantly higher rate of positive peritoneal cytology results compared with no hysteroscopy. In addition, when a liquid medium was used for uterine distention during hysteroscopy, the difference between the two groups remained statistically significant. However, no statistically significant differences were seen when inflation pressure reached or exceeded 100 mm Hg or when the cancer stage was early. Trials that examined long-term outcomes reported no statistically significant differences in disease prognosis between the two groups. Conclusion(s): Hysteroscopic examination before surgery in patients with endometrial cancer may increase the risk of dissemination of malignant cells into the peritoneal cavity. The risk was statistically significantly associated with the use of a liquid medium for uterine cavity distention but not with early-stage disease. There is no evidence to support an association between preoperative hysteroscopic examination and a worse prognosis. There is no reason to avoid diagnostic hysteroscopy before to surgery in patients with endometrial cancer, especially in early stages. (Fertil Steril (R) 2011; 96: 957-61. (C)2011 by American Society for Reproductive Medicine.)