The use of hysteroscopy in endometrial cancer: old questions and novel challenges

Abstract

Endometrial cancer is the most common gynecological malignancy with a relatively good overall prognosis. It traditionally has two subtypes: type 1 (endometrioid carcinoma) and type 2 (non-endometrioid carcinoma). The prognosis is excellent for stage I endometrioid cancer, with a 5-year survival rate of 96%. However, the prognosis is much worse for women with high-risk endometrial cancer. Effective preoperative staging is important in order to tailor treatment and achieve optimal long-term survival. The majority of asymptomatic polyps detected by ultrasound are treated surgically. Conventionally, dilatation and curettage was performed to obtain a histological diagnosis, but nowadays hysteroscopy with biopsy is starting to be considered as the gold standard. Hysteroscopic resection seems to reduce the risk of underdiagnosed (atypical endometrial hyperplasia) endometrial cancer. To avoid the spread of malignant cells, hysteroscopy should be performed with concern to keep intrauterine pressure low. In comparison with cervical injection, the hysteroscopic method has a better detection rate in the para-aortic area during sentinel lymph node mapping. In the assessment of cervical involvement, the accuracy of magnetic resonance imaging is significantly higher than the accuracy of hysteroscopy. In fertility-sparing cases, hysteroscopic endometrium resection with progesterone therapy is an acceptable option.

摘要

子宫内膜癌是最常见的妇科恶性肿瘤, 总体预后较好。传统上有两种亚型：1型（子宫内膜样癌）和2型（非子宫内膜样癌）。I期子宫内膜样癌预后良好, 5年生存率96%。然而, 高危型子宫内膜癌的预后很差。有效的术前分期对于制定治疗方案和获得最佳长期生存率非常重要。超声检查发现的无症状息肉大多是通过手术治疗的。传统上, 通过子宫颈扩张和刮宫术获得组织学诊断, 但现在宫腔镜下的活检开始被认为是金标准。宫腔镜下切除术似乎降低了（非典型子宫内膜增生）子宫内膜癌漏诊的风险。为避免恶性细胞的扩散, 宫腔镜检查时应注意保持宫腔内的低压状态。在前哨淋巴结定位时, 应用宫腔镜的方法对主动脉旁区的前哨淋巴结检出率高于通过宫颈注射的检出率。在宫颈病变的评估中, 磁共振成像的准确性明显高于宫腔镜检查的准确性。在保留生育能力的病例中, 宫腔镜下子宫内膜切除加孕激素治疗是一个可接受的选择。

Keywords:

• Endometrial cancer
• hysteroscopy
• magnetic resonance imaging
• curettage
• ultrasound
• staging

Potential conflict of interest

No potential conflict of interest was reported by the authors.

Source of funding

Nil.