Are endometrial carcinoma cells disseminated at hysteroscopy functionally viable?

Objective. The aim of this study was to evaluate the late of transtubal dis semination of endometrial carcinoma cells by hysteroscopy and the functiona l viability of disseminated tumor cells by assessing cell adhesion in an in vitro model. Methods. We studied 24 uteri obtained at TAH+BSO in patients with endometri al carcinoma. Further inclusion criteria were negative peritoneal cytology, no involvement of the uterine serosa or extrauterine disease, and endometr ial surface involvement >1 cm in diameter. In vitro fluid hysteroscopy was performed with a 5-mm. single-flow rigid hysteroscope. A maximum of 150 ml saline was infused at a maximum pressure of 100 mm Hg for a maximum of 3 mi n. Fluid running off through the tubes was collected. The cell suspension w as enriched by a density gradient centrifugation. The isolated cells had a mean viability of 90% as judged by trypan blue exclusion. Viable cells (5 X 10(4) per 2-cm(2) polyvinyl chloride well plate) were cultured with equal parts of Dulbecco's modified Eagle's minimal essential medium and Ham's F-1 2 for 24 h. The endpoint of the analysis was the adherence of tumor cells t o the polyvinyl chloride well plate, which was taken as a proxy for functio nal cell viability. Cytological evaluation was performed separately by two cytologists blinded to the source and date of the smears. Results. Transtubal fluid dissemination was seen in 20 of 24 (83%) uteri. T umor cells were found in 17 specimens (71%). In 10 (42%) specimens the diss eminated tumor cells were functionally viable. Conclusions. Our model suggests that hysteroscopy can cause dissemination o f malignant cells into the abdominal cavity from uteri containing endometri al carcinoma and that these cells can be functionally viable and adhere to a matrix. (C) 2001 Academic Press.