Hysteroscopy for diagnosis and treatment of endometrial adenocarcinoma precursors. A review of literature.

The guidelines for early detection of adenocarcinoma and its precursors are controversial. Ultrasound, due to its non invasive nature, could represent a useful technique for screening patients at risk but its specificity is low. Endometrial cytology, especially by using new device, is an effective, easy, and inexpensive method for screening asymptomatic women; however, cytologic investigation shows some limits due to the scarce desquamation of endometrial cells and to the difficulty in diagnosing hyperplasia. Blind biopsy can miss the pathology in cases of focal lesions. Dilatation and curettage gives, in most cases, a certain histologic diagnosis but, requiring anesthesia and hospitalization, is not suitable for mass screening; moreover, in cases of focal lesions its sensitivity is low. Microhysteroscopy allows an atraumatic and direct investigation of the uterine cavity and could be used as a routine basis in patients with risk factors for endometrial pathology and signs of hyperestrogenism. In symptomatic patients its employment must be considered necessary for a correct and modern management of these patients. Operative hysteroscopy represents a promising way for treating hyperplastic endometrial lesions without signs of atypia, but its value in comparison with hysterectomy must be confirmed; when atypia is found, hysterectomy is the treatment of choice.