Occult Malignancy Incidence and Preoperative Assessment in Hysterectomies with Morcellation

Abstract

Abstract

Objective:

The aims of this research were to quantify the incidence of malignancy in women undergoing hysterectomy for benign indications and to compare the preoperative evaluation of patients undergoing hysterectomy with and without morcellation.

Materials and Methods:

This retrospective cohort study identified women undergoing hysterectomies between October 2007 and June 2014. Chart abstraction included demographics; prehysterectomy evaluation, including current cervical cytology, pathologic endometrial assessment (biopsy, dilation and curettage [D&C]); and imaging (ultrasound, magnetic resonance imaging, computed tomography); intraoperative factors; and final pathology.

Results:

The analyzed cohort included 2309 women undergoing hysterectomy with 396 (17.1%) who had morcellation. Women undergoing hysterectomy with morcellation were, on average, younger, compared to those having hysterectomy without morcellation (33.4 ± 18.8 versus 39.7 ± 17.6; p < 0.001). The incidence of malignancy was 1.7% and was different between nonmorcellated versus morcellated specimens (2.0% versus 0.3%; p < 0.001). There was no significant difference in preoperative cervical cytology (68.9% versus 71.0%) and imaging (39.6% versus 35.2%) assessment rates between the nonmorcellated versus morcellated groups; however, patients who had morcellation were less likely to have had preoperative pathologic endometrial assessments (21.7% versus 34.1%; p < 0.001).

Conclusions:

The risk of occult malignancy noted during hysterectomy was low overall. Preoperative evaluation of patients undergoing hysterectomy with morcellation was similar to those without morcellation, except for lower rates of endometrial assessment by biopsy or D&C. Given the concern for possible dissemination of occult malignancy with morcellation, one may consider preoperative assessment with endometrial biopsy prior to surgery or contained morcellation. The cost-efficacy and clinical efficacy of this warrants further investigation. (J GYNECOL SURG 34:18)