Previous studies have shown that transtubal dissemination of both fluid and malignant cells can occur during sonohysterography in patients with endometrial cancer, but the viability of these cells is unknown. This prospective study evaluated the occurrence of transtubal spill at laparotomy in patients with endometrial adenocarcinoma during sonohysterography and determined whether the spill volume was critical, and the disseminated cancer cells were viable.
The participants were 16 evaluable patients with clinical stage I–IIA endometrial adenocarcinoma who underwent surgical treatment for endometrial carcinoma.
The volumes required to obtain an adequate sonohysterography and at which tubal spill occurred were recorded. After processing and incubation of the collected specimens, the cells were examined for viability and cytologic analysis was performed.
During adequate sonohysterography, the median volume that was required to perform sonohysterography was 8.5 ml (overall range, 1–90 ml; interquartile range, 5–21 ml). Of the 16 patients evaluated, 5 (31%; 95% confidence level CI, 14%–56%) had a transtubal spill at volume values between 1 and 20 ml of instilled saline solution.
After an additional saline flush, the median total volume at which transtubal spill occurred was 20.5 ml (interquartile range, 9 ml to no spill [range: 1 to >140 ml]). The median total spill volume (20.5 ml) was more than twice that required for performance of an adequate sonohysterography (8.5 ml). There was no critical spill volume at which tubal spill occurred. Viable benign cells were disseminated in two patients (12.5%), and nonviable adenocarcinoma cells were identified in one patient (6.25%).
These findings suggest that sonohysterography poses a low risk of transtubal dissemination of viable cancer cells. To the authors’ knowledge, this is the first published study to examine cells for viability.