title: Risk of long-term pelvic recurrences after fluid minihysteroscopy in women with endometrial carcinoma: a controlled randomized study.
abstract: OBJECTIVE
  Concerns exist about the risk of endometrial cancer cells spreading into the peritoneal cavity after fluid minihysteroscopy. The aim of our study was to evaluate the 5-year incidence of pelvic recurrences in women affected by early-stage endometrial carcinoma (stage IA or IB) who did or did not undergo preoperative hysteroscopy with low pressure (<70 mm Hg) saline uterine distention.
  
  
  METHODS
  A total of 140 women were randomized into two groups of 70 women who underwent or did not undergo diagnostic fluid minihysteroscopy before surgical staging. Women were followed up every 6 months for at least 5 years. Diagnosis of pelvic recurrence was based on a positive result at clinical examination and/or at vaginal cytology and/or at magnetic resonance imaging/positron emission tomography scan. Univariate analysis of disease-free survival was performed with the Kaplan-Meier method and survival curves were compared using the long-rank test.
  
  
  RESULTS
  No difference in peritoneal cytology was observed between the two groups (5.7% and 8.5% of cases in the hysteroscopy and control group, respectively). After a mean duration of follow-up of 62 months, 2 (2.85%) pelvic recurrences in the hysteroscopy group and 3 (4.28%) in the control group were found. No significant difference was found between the two groups when the recurrence rate was compared. Overall survival rates and disease-free survival projected by Kaplan-Meier curves were not significantly different for the two groups.
  
  
  CONCLUSIONS
  Preoperative low-pressure fluid minihysteroscopy does not increase the risk of intraperitoneal transport of endometrial carcinoma cells during the examination or the risk of pelvic recurrence at the 5-year follow-up. It does not seem to modify the recurrence rate, disease-free survival, and overall survival, although multicenter randomized trials and long-term follow-up are required to evaluate the overall oncologic outcomes of this procedure.
authors.affiliation: Department of Obstetrics and Gynecology, University Medical School of Bari, 70124 Bari, Italy. cicinelli@gynecology1.uniba.it
authors.forename: Ettore
authors.initials: E
authors.lastname: Cicinelli
authors.forename: Raffaele
authors.initials: R
authors.lastname: Tinelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Colafiglio
authors.forename: Francesca
authors.initials: F
authors.lastname: Fortunato
authors.forename: Annarita
authors.initials: A
authors.lastname: Fusco
authors.forename: Salvatore
authors.initials: S
authors.lastname: Mastrolia
authors.forename: Anna Rosa
authors.initials: AR
authors.lastname: Fucci
authors.forename: Achiropita
authors.initials: A
authors.lastname: Lepera
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects* / Q000706:statistics & numerical data; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology*; D009366:Neoplasm Seeding; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000453:epidemiology / Q000473:pathology*; D010808:Physical Examination; D011300:Preoperative Care / Q000009:adverse effects / Q000706:statistics & numerical data; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis