Abstract：
OBJECTIVE: It has been suggested that the manipulation of neoplastic tissue during hysteroscopy may lead to dissemination of tumor cells into the peritoneal cavity and worsen prognosis and overall survival. The goal of this study was to assess the oncological safety comparing hysteroscopy to Pipelle blind biopsy in the presurgical diagnosis of patients with endometrial cancer.
METHODS: We performed a retrospective multicentric study among patients who had received primary surgical treatment for endometrial cancer. A multivariate statistical analysis model was used to compare relapse and survival rates in patients who had been evaluated preoperatively either by hysteroscopy or Pipelle biopsy. The relapse rate, disease-free survival, and overall survival were assessed as the main outcomes. The histological type, tumor size, myometrial invasion, International Federation of Gynecology and Obstetrics (FIGO) stage, surgical approach, use of a uterine manipulator, and adjuvant treatment were also included in the analysis.
RESULTS: A total of 1731 women from 15 centers were included: 1044 in the hysteroscopy group and 687 in the Pipelle sampling group. 225 patients relapsed during the 10 year follow-up period: 139 (13.3%) in the hysteroscopy group and 86 (12.4%) in the Pipelle sampling group. There is no evidence of an association between the use of hysteroscopy as a diagnostic method and relapse rate (HR 1.24, 95% CI 0.92 to 1.66; p=0.16), lower disease-free survival (HR 1.23, 95% CI 0.92 to 1.66; p=0.15), or overall survival (HR 0.95, 95% CI 0.70 to 1.29; p=0.76).
CONCLUSIONS: Hysteroscopy is a safe diagnostic method for patients with endometrial cancer with no impact on oncological outcomes when compared with sampling by Pipelle.
METHODS: We performed a retrospective multicentric study among patients who had received primary surgical treatment for endometrial cancer. A multivariate statistical analysis model was used to compare relapse and survival rates in patients who had been evaluated preoperatively either by hysteroscopy or Pipelle biopsy. The relapse rate, disease-free survival, and overall survival were assessed as the main outcomes. The histological type, tumor size, myometrial invasion, International Federation of Gynecology and Obstetrics (FIGO) stage, surgical approach, use of a uterine manipulator, and adjuvant treatment were also included in the analysis.
RESULTS: A total of 1731 women from 15 centers were included: 1044 in the hysteroscopy group and 687 in the Pipelle sampling group. 225 patients relapsed during the 10 year follow-up period: 139 (13.3%) in the hysteroscopy group and 86 (12.4%) in the Pipelle sampling group. There is no evidence of an association between the use of hysteroscopy as a diagnostic method and relapse rate (HR 1.24, 95% CI 0.92 to 1.66; p=0.16), lower disease-free survival (HR 1.23, 95% CI 0.92 to 1.66; p=0.15), or overall survival (HR 0.95, 95% CI 0.70 to 1.29; p=0.76).
CONCLUSIONS: Hysteroscopy is a safe diagnostic method for patients with endometrial cancer with no impact on oncological outcomes when compared with sampling by Pipelle.
摘要：
目的：有人认为，宫腔镜检查中对肿瘤组织的操作可能导致肿瘤细胞扩散到腹膜腔，并恶化预后和总生存期。这项研究的目的是评估在子宫内膜癌患者的术前诊断中比较宫腔镜与Pipelle盲活检的肿瘤学安全性。
方法：我们在接受子宫内膜癌初级手术治疗的患者中进行了一项回顾性多中心研究。多变量统计分析模型用于比较术前通过宫腔镜检查或Pipelle活检评估的患者的复发率和生存率。复发率，无病生存,和总生存期作为主要结局进行评估.组织学类型,肿瘤大小,子宫肌层浸润，国际妇产科联合会（FIGO）阶段，手术方法,使用子宫操纵器，和辅助治疗也包括在分析中。
结果：共有来自15个中心的1731名妇女被纳入：宫腔镜检查组1044名，Pipelle采样组687名。225例患者在10年随访期间复发：宫腔镜检查组139例（13.3％），Pipelle采样组86例（12.4％）。没有证据表明使用宫腔镜作为诊断方法与复发率之间存在关联（HR1.24，95％CI0.92至1.66；p=0.16），无病生存率较低(HR1.23，95%CI0.92至1.66；p=0.15)，或总生存期（HR0.95，95%CI0.70至1.29；p=0.76）。
结论：与Pipelle采样相比，宫腔镜检查是子宫内膜癌患者的一种安全诊断方法，对肿瘤预后没有影响。
方法：我们在接受子宫内膜癌初级手术治疗的患者中进行了一项回顾性多中心研究。多变量统计分析模型用于比较术前通过宫腔镜检查或Pipelle活检评估的患者的复发率和生存率。复发率，无病生存,和总生存期作为主要结局进行评估.组织学类型,肿瘤大小,子宫肌层浸润，国际妇产科联合会（FIGO）阶段，手术方法,使用子宫操纵器，和辅助治疗也包括在分析中。
结果：共有来自15个中心的1731名妇女被纳入：宫腔镜检查组1044名，Pipelle采样组687名。225例患者在10年随访期间复发：宫腔镜检查组139例（13.3％），Pipelle采样组86例（12.4％）。没有证据表明使用宫腔镜作为诊断方法与复发率之间存在关联（HR1.24，95％CI0.92至1.66；p=0.16），无病生存率较低(HR1.23，95%CI0.92至1.66；p=0.15)，或总生存期（HR0.95，95%CI0.70至1.29；p=0.76）。
结论：与Pipelle采样相比，宫腔镜检查是子宫内膜癌患者的一种安全诊断方法，对肿瘤预后没有影响。
