Office Hysteroscopy: Its Relevance as a Screening Method in High-Risk Asymptomatic Patients.

Abstract

Study Objective

To develop a screening strategy for high-risk asymptomatic patients for endometrial cancer.

Design

Single Prospective Cohort.

Setting

Gynecological Medical Office. We did not use anesthesia.

Patients or Participants

We developed screening protocol for high-risk asymptomatic patients, conducting triennial screenings with OH from Jan 2003 to Jan 2023. Used Dotto et al. Classification for Hysteroscopic Risk Assessment. Studied 2076 high-risk patients (35-65 yo, mean age 51.4 yo) with risk factors including obesity, diabetes, cancer history, tamoxifen use, PCOS, HRT. Hypertension required an additional risk factor for enrollment. 41 patients excluded; final population 2035. All asymptomatic at recruitment. Diagnosed patients with endometrial cancer were removed from program for treatment.

Interventions

Office Hysteroscopy.

Measurements and Main Results

Screening protocol for high-risk asymptomatic patients for endometrial cancer, performing a screening office (OH) every three years in the targeted group. Between 2003 and 2023 we performed a total of 14439 OH in high-risk patients for endometrial cancer. Findings: 2003: 27 AH (Atypical Hyperplasia) 24 CA (carcinomas) PMDR 2.5% (Premalignant + Malignant Detection Rate) 2006: AH 22 CA 16 PMDR 1.93%, 2009 AH 24 CA 18 PMDR 2.25%, 2012: AH 27 CA14 PMDR 3.32%, 2015 AH 23 CA 13 PMDR 2.09%, 2018 AH 29 CA 22 PMDR 3% 2021 AH26 CA 15 PMDR 2.54% 2023: AH 28 CA 31 PMDR 3.66%.

Conclusion

We propose the use of office hysteroscopy as a screening method for high-risk for endometrial cancer asymptomatic patients. OH has the capacity of detecting lesions at an earlier stage, this widens the therapeutic window providing the patients with a greater chance of cure. This technique allowed us to diagnose endometrial cancer and premalignant lesions that were missed by transvaginal ultrasound.