Introduction:Endometrial cancer is the most common malignancy of the female genital tract in high-income countries. A prompt diagnosis of this condition is of utmost importance in ensuring that patients receive the best treatment strategy. The new FIGO 2023 molecular classification of endometrial cancer radically changes the current landscape of this disease’s treatment and follow-up. Among the various diagnostic techniques used to identify endometrial lesions, hysteroscopy and vacuum biopsy techniques are the most employed in clinical practice. The aim of this systematic literature review is to compare the efficacy, sensitivity, specificity, and safety of these methods when employed to diagnose endometrial cancer, as well as to assess the feasibility of endometrial cancer molecular profiling on biopsy specimens.Methods:A systematic literature search of studies evaluating hysteroscopy and VABRA biopsy performance in diagnosing endometrial cancer was conducted using the main online databases (PubMed, EMBase, Cochrane Library). An additional literature search was conducted, focusing on the feasibility of endometrial cancer molecular profiling on hysteroscopic biopsy and VABRA samples, as well as on the diagnostic concordance of biopsy and final surgery specimens. Two authors performed the literature search independently, while other two authors assessed the retrieved publications’ risk of bias using Begg’s and Egger’s tests. Twenty-four studies were included in the final report.Results:Both techniques have shown high effectiveness in diagnosing endometrial cancer, although with important differences. Hysteroscopy provides direct visualization of the endometrium and allows clinicians to perform biopsies of suspicious lesions, but it also entails important limitations, as in the case of diffused lesions or technical difficulties, especially in nulliparous and elderly women. VABRA and other vacuum biopsy techniques, on the other hand, offer a wider sampling of endometrial tissue and are less operator-dependent but may be associated with a higher risk of failed diagnosis when compared to hysteroscopy.Discussion:Hysteroscopy, especially when combined with targeted biopsies, has been proven to be a valid technique, especially in pre-surgical diagnostic workup of early-stage endometrial cancer. Vacuum techniques, although less invasive and providing larger tissue samples, do not seem to be able to completely replace hysteroscopy in diagnosing endometrial cancer but remain a valid alternative in selected cases, especially when endometrial lesions prove harder to reach and/or to identify. They may also prove useful in low resource countries in which hysteroscopy is not widely available.Conclusions:Based on our findings, early assessment of endometrial cancer should be carried out through hysteroscopic evaluation and targeted endometrial biopsies, ideally including molecular assessment on biopsy specimens to further guide treatment decisions. Other biopsy techniques, such as vacuum-assisted biopsy, should be reserved for specific settings in which hysteroscopy is not readily available. The ideal diagnostic approach to endometrial cancer should take multiple factors into account, such as the location and extension of the disease, patient characteristics, clinical skills, and resource availability. Further studies are needed to assess the feasibility of molecular cancer profiling on biopsy specimens, as well as cost-containment strategies which would allow equal access to targeted treatment modalities for all endometrial cancer patients worldwide.
引言：子宫内膜癌是高收入国家女性生殖道最常见的恶性肿瘤。及时诊断对于确保患者获得最佳治疗策略至关重要。FIGO 2023年新版子宫内膜癌分子分型从根本上改变了该疾病的治疗和随访现状。在用于识别子宫内膜病变的各种诊断技术中，宫腔镜检查和真空活检技术在临床实践中应用最为广泛。本系统性文献综述旨在比较这两种方法在诊断子宫内膜癌时的有效性、敏感性、特异性和安全性，并评估活检标本进行子宫内膜癌分子谱分析的可行性。 方法：通过主要在线数据库（PubMed、EMBase、Cochrane Library）对评估宫腔镜和VABRA活检在诊断子宫内膜癌中表现的研究进行了系统性文献检索。同时额外检索了关注宫腔镜活检和VABRA样本进行子宫内膜癌分子谱分析的可行性，以及活检与最终手术标本诊断一致性的文献。由两位作者独立进行文献检索，另外两位作者使用Begg's和Egger's检验评估所获文献的偏倚风险。最终报告共纳入24项研究。 结果：两种技术在诊断子宫内膜癌方面均显示出高效性，但也存在重要差异。宫腔镜可直接观察子宫内膜，允许临床医生对可疑病变进行活检，但也存在重要局限性，例如在弥漫性病变或技术困难的情况下，尤其对于未生育女性和老年女性。相比之下，VABRA及其他真空活检技术能获取更广泛的子宫内膜组织样本，且对操作者依赖性较低，但与宫腔镜相比，可能存在更高的漏诊风险。 讨论：宫腔镜检查，尤其是结合靶向活检，已被证明是一种有效的技术，特别是在早期子宫内膜癌的术前诊断评估中。真空活检技术虽然创伤更小并能提供更大的组织样本，但在诊断子宫内膜癌方面似乎无法完全替代宫腔镜，但在特定病例中仍是有效的替代选择，特别是当子宫内膜病变难以触及和/或识别时。在宫腔镜未广泛普及的低资源国家，这些技术也可能被证明是有用的。 结论：基于我们的研究结果，子宫内膜癌的早期评估应通过宫腔镜检查和靶向子宫内膜活检进行，理想情况下应包括活检标本的分子评估，以进一步指导治疗决策。其他活检技术，如真空辅助活检，应保留用于宫腔镜检查不易获得的特定情况。理想的子宫内膜癌诊断方法应综合考虑多种因素，如疾病的位置和范围、患者特征、临床技能和资源可用性。需要进一步研究评估活检标本进行癌症分子谱分析的可行性，以及成本控制策略，以使全球所有子宫内膜癌患者都能平等获得靶向治疗方式。
Hysteroscopy vs. Vabra in Endometrial Cancer Diagnosis: A Systematic Review of the Literature
肿瘤(癌症)患者之家