Does hysteroscopy facilitate tumor cell dissemination? Incidence of peritoneal cytology from patients wild early stage endometrial carcinoma following dilatation and curettage (D & C) versus hysteroscopy and D & C

BACKGROUND. In several case reports, distension and irrigation of the uteri ne cavity during fluid hysteroscopy was suspected to cause tumor cell disse mination into the abdominal cavity in patients with endometrial carcinoma. It was the aim of this study to compare the incidence of positive peritonea l cytology in patients who underwent dilatation and curettage (D & C) with or without previous hysteroscopy. METHODS. The authors conducted a multicentric, retrospective cohort analysi s. One hundred thirteen consecutive patients with endometrial carcinoma tre ated between 1996 and 1997 were included. Endometrial carcinoma had to be l imited to the inner half or less than the inner half of the myometrium (pat hologic Stage IA,B). Positive peritoneal cytology was obtained during stagi ng laparotomy. Patients underwent D & C either with or without prior diagno stic fluid hysteroscopy. No selection or randomization was applied to the t rue groups. Positive peritoneal cytology, defined as malignant or suspiciou s, was considered the primary statistical endpoint. RESULTS. Peritoneal cytology was suspicious or positive in 10 of 113 patien ts (9%). The presence of suspicious or positive peritoneal cytology was ass ociated with a history of hysteroscopy (P = 0.04) but not with myometrial i nvasion (P = 0.57), histologic subtype (P = 1.00) or grade (r = 0.16, P = 0 .10), or the time between D & C and staging laparotomy (r = 0.04, P = 0.66) . CONCLUSIONS, Based on the limited extent of endometrial carcinoma in the cu rrent analysis, our data strongly suggest dissemination of endometrial carc inoma cells after fluid hysteroscopy. Determining whether a positive perito neal cytology affects the prognoses of patients without further evidence of extrauterine disease will require longer follow-up. Cancer 2000;88:139-43. (C) 2000 American Cancer Society.