Hysteroscopic Morcellation in Endometrial Cancer Diagnosis: Increased Risk?


Study Objective

Operative hysteroscopy requires elevated intrauterine pressures, which could lead to spread of malignant cells into the peritoneal cavity. Currently, there is paucity of data analyzing clinical outcomes in endometrial cancer following hysteroscopic morcellation with newer equipment. In this study, we sought to determine whether there are increased rates of positive peritoneal cytology, lymphovascular space invasion, or surgical upstaging in patients undergoing hysteroscopic morcellation compared to alternative endometrial biopsy methods.


Retrospective chart review of patients (2013-2018) was performed at the Karmanos Cancer Institute in Detroit, Michigan. Exclusion criteria included: biopsy at outside institution, stage IV endometrial cancer known prior to biopsy and missing data regarding biopsy method and histology.  Peritoneal cytology results, lymphovascular space invasion and surgical staging were compared by method of biopsy and histology using Chi-squared and Krustal-Wallis tests.


289 patients met the inclusion criteria. 184 patients were classified as low grade (FIGO Grade 1 and 2) and 105 as high grade (FIGO Grade 3, serous, clear cell and carcinosarcoma) endometrial cancer respectively.


53 patients (18%) underwent hysteroscopy with morcellation. Alternative biopsy methods included: hysteroscopy without morcellation n=81 (28%), endometrial biopsy n=112 (38.7%), dilation and curettage n=43 (15%).

Measurements/Main Results

Positive peritoneal cytology was noted in 34 cases (12%) and negative cytology in 165 (57%). Cytology was not performed in 90 cases (31%). When comparing outcomes by histologic subtypes, no difference was seen in peritoneal cytology (p=0.704 and 0.727 for Low grade and High grade), stage (p=0.773 and 0.053 for Low Grade and High Grade) or lymphovascular space invasion (p=0.400 and 0.142 Low grade and High grade).


Our study demonstrates that hysteroscopy with morcellation is a safe diagnostic method for Low- and High-Grade endometrial pathologies and does not lead to increased dissemination of malignant cells, lymphovascular space invasion nor upstaging of patients.


Endometrial cancer is the most common gynecologic malignancy and the fourth leading cause of cancer in the United States, with incidence rates that continue to rise.

  • Constantine G
  • Kessler G
  • Graham S.
  • Goldstein S.
Increased Incidence of Endometrial Cancer Following the Women’s Health Initiative: An Assessment of Risk Factors.