The Relations Between Hysteroscopy And Positive Peritoneal Cytology With Endometrial Carcinoma

Objectives To Study whether hysteroscopy check increase the positive peritoneal cytology among women with endometrial carcinoma and relevant factors with positive peritoneal cytology.Methods To retrospectively analyze 247 cases of endometrial cancer patients received surgical treatment in Qilu hospital from June 2003 to June 2008,There are 224 patients having peritoneal washings examination results and integrity postoperative pathologic data for research object. Preoperative diagnosed by hysteroscopy and D&C will be for contrasting analysis.Results 1.there are 224 patients having integrity postoperative pathologic data and results of peritoneal cytology,Patients with an average age of 55(29-75).Among the 40 cases preoperative diagnosed by hysteroscopy,4 cases of them diagnosed by hysteroscopy after D&C,184 patients diagnosed by D&C.149 patients were menopause.2.There are 50 patients peritoneal washings found cancer cell,10 cases preoperative diagnosed by hysteroscopy,40 cases preoperative diagnosed by D&C.202 cases postoperative pathologic results were endometrioid adenocarcinoma,including 45 patients peritoneal cytology were positive,other 22 cases pathological types including clear cell carcinoma,papillary serous carcinoma,squamous carcinoma,5 patients peritoneal cytology were positive.3.Surgical-pathological staging:154 patients were diagnosed as having stageⅠdisease,and 69 patients with stageⅢincluding 17 patients with stageⅢa 17 patients with stageⅢc,and 1 patient with stageⅣdisease.Positive peritoneal cytology were found in 37 patients while they tumors were limited to the endometrial,One patient the tumor invaded the cervix,31 patients the tumors outside the endometrial,in 12 of them endometrial cytology were positive.4.The peritoneal cytology was positive in 22.32%(50/224) of the 224 patients.The peritoneal cytology was positive in 25.00%of the endometrial cancer patients diagnosed by hysteroscopy,which was higher than that 21.74%of the patients diagnosed by D&C while no statistical difference was found(P＞0.05).The peritoneal cytology have no relations with tumor differentiation(grade),myometrial invasion and histotype. In this study the peritoneal cytology was positive in 29.63%of patients with poor-differentiated tumor,in 29.27%of patients with myometrial invasion＞50%which was higher than that patients with well-differentiated tumor 21.50%and myometrial invasion＜50%20.77%, while no statistical difference was found(P＞0.05).The peritoneal cytology was positive in 39.40%of patients with stageⅡ-Ⅳ,in 33.85% of patients with tumor diffused in endometrial which was higher than that patients with stageⅠ(19.37%) and focal lesions in endometrial(17.61%), while statistical difference was found(P＜0.05).And no statistical difference was found of peritoneal cytology positive rate between preoperative diagnosed by hysteroscopy and D&C.Conclusion 1.the diagnostic hysteroscopy overcome the blindness of D&C,to the early stage or small lesion tumor may be missed by D&C.The visual and amplification effect to the early stage or small lesion tumor of hysteroscopy can not matched by D&C.But due to the cost,equipment and technical requirements,D&C is still a major diagnosis method in our country at present,in our study only 40 patients preoperative diagnosed by hysteroscopy.2.Is this study diagnostic hysteroscopy had no adverse effect on the incidence of positive peritoneal washing.The diagnostic hysteroscopy as same as D&C positive peritoneal cytology directly relevant with the clinical stages and tumor distribution in endometrial.There are no direct relations with other independent factors such as tumor differentiation (grade),myometrial invasion and histotype.3.In 52 patients with stageⅢa disease 14 patients tumor invades the serosa of the corpus uteri and/or adnexal in which 6 patients peritoneal washings found cancer cell,the others 37 patients positive peritoneal cytology only.The results of positive peritoneal cytology made incidence of stageⅢa increase by 16.96%.