From the Guidelines
Blind curettage is not recommended for advanced high-grade endometrial cancer diagnosed during hysteroscopy, as it may lead to inadequate sampling and underestimation of the disease extent. Instead, a directed biopsy of the suspicious lesion should be performed under direct visualization to ensure accurate diagnosis and staging. This approach is supported by the most recent guidelines, such as the NCCN Guidelines for Endometrial Cancer 1, which emphasize the importance of accurate diagnosis and staging in determining the optimal treatment strategy.
The management of advanced high-grade endometrial cancer typically involves a multidisciplinary approach with gynecologic oncologists, and may include surgical staging with hysterectomy, bilateral salpingo-oophorectomy, and lymph node assessment, possibly followed by adjuvant therapy based on final pathology and staging results. Comprehensive evaluation should include imaging studies, such as MRI or CT scan, to assess the extent of disease.
Some key points to consider in the management of advanced high-grade endometrial cancer include:
- Accurate diagnosis and staging are crucial in determining the optimal treatment strategy
- Directed biopsy under direct visualization is preferred over blind curettage
- Multidisciplinary approach with gynecologic oncologists is essential
- Surgical staging and adjuvant therapy may be necessary based on final pathology and staging results
- Imaging studies, such as MRI or CT scan, should be used to assess the extent of disease
The evidence from previous studies, such as the GOG-122 trial 1, supports the use of chemotherapy in the treatment of advanced endometrial cancer, with significant improvements in progression-free survival and overall survival compared to whole abdominal radiation. However, the most recent guidelines 1 should be prioritized in determining the optimal treatment strategy.
From the Research
Diagnosis and Treatment of Endometrial Cancer
- The use of hysteroscopy in endometrial cancer diagnosis is becoming more prevalent, with studies suggesting it is a useful procedure for diagnosing endometrial cancer 2.
- Hysteroscopy with directed biopsy has been shown to be more sensitive in disclosing all types of uterine lesions than dilatation and curettage 3.
- However, the accuracy of preoperative biopsy, regardless of the method, has its limitations in predicting the tumor grade compared to the final surgical specimen in women with endometrioid endometrial cancer at an apparent early stage 4.
Hysteroscopic Morcellation and Endometrial Cancer
- Operative hysteroscopy requires elevated intrauterine pressures, which could lead to the spread of malignant cells into the peritoneal cavity 5.
- However, a study found that hysteroscopy with morcellation is a safe diagnostic method for low- and high-grade endometrial pathologic conditions and does not lead to increased dissemination of malignant cells, lymphovascular space invasion, or upstaging of patients 5.
Prognosis of Patients with Endometrial Cancer
- A multicenter retrospective study found that there was no significant difference in overall survival or recurrence-free survival between patients who underwent hysteroscopy and those who underwent dilatation and curettage 6.
- The study also found that hysteroscopic examination and lesion biopsy, under certain inflation pressure and distension medium, ensure safety and have no adverse effects on prognosis compared to conventional curettage 6.
Blind Curettage for Advanced High-Grade Endometrial Cancer
- There is no direct evidence to suggest that blind curettage is recommended for advanced high-grade endometrial cancer diagnosed during hysteroscopy.
- However, studies suggest that hysteroscopy with directed biopsy is a more sensitive and accurate method for diagnosing endometrial cancer, and that it does not affect the prognosis of endometrial cancer 2, 3, 6.