The Incidence of Malignancy and the Preoperative Assessment of Women Undergoing Hysterectomy with Morcellation for Benign Indications
Authors
Wilkie, Gianna L.Reus, Emily
Leung, Katherine G.
Bradford, Leslie
Manning, Mark
Moore Simas, Tiffany A.
Faculty Advisor
Tiffany Moore Simas, MD, MPH, MEdUMass Chan Affiliations
Department of Obstetrics and GynecologySenior Scholars Program
School of Medicine
Document Type
PosterPublication Date
2016-04-27Keywords
hysterectomymorcellation
malignancy
Female Urogenital Diseases and Pregnancy Complications
Neoplasms
Obstetrics and Gynecology
Oncology
Women's Health
Metadata
Show full item recordAbstract
Background: The use of power morcellation in gynecologic surgery has come under scrutiny secondary to concerns for occult malignancy dissemination. The incidence of undiagnosed gynecologic malignancy when hysterectomy performed for benign indications is not definitive but has been quoted as high as 2.7% (1:37). There is not a standard recommended preoperative evaluation, and variation is anticipated by preoperative complaint or diagnosis. Objectives: To quantify the malignancy incidence in women undergoing hysterectomy for benign indications and to compare the preoperative evaluation of patients undergoing hysterectomy with and without morcellation. Methods: Retrospective cohort of women undergoing hysterectomies between October 2007 and June 2014 was identified by procedural codes through the hospital billing system. Exclusions included hysterectomies performed by gynecologic oncologists or non-gynecologic surgeons and surgeries performed outside the UMass healthcare system. Chart abstraction included demographics; pre-hysterectomy evaluation, including current cervical cytology, pathologic endometrial assessment (biopsy, dilation and curettage), and imaging (ultrasound, MRI, CT scan, sonohysterogram, or hysteroscopy); intraoperative factors; and final diagnosis. Results: Analytic cohort included 2,332 women undergoing hysterectomy with 396 (17.0%) including use of morcellation. The malignancy incidence on final pathology was 2.1% and was different between non-morcellated versus morcellated specimens (2.5% vs. 0.3%, p Conclusion: The incidence of malignancy at time ofhysterectomy performed by non-oncology trained gynecologists was 2.1% overall, and 0.3% in morcellated cases. The pre-operative evaluation of patients undergoing hysterectomy with morcellation is similar to those without morcellation, except for lower rates of pathologic endometrial assessment. An argument could be made that a pathology assessment is indicated in this group due to risk of dissemination in the case of occult malignancy. The risk of occult malignancy is rare, but this should be discussed with patients and taken into account during the pre-operative evaluation.DOI
10.13028/t1we-dg27Permanent Link to this Item
http://hdl.handle.net/20.500.14038/49296Notes
Gianna Wilkie participated in this study as a medical student as part of the Senior Scholars research program at the University of Massachusetts Medical School. This poster was presented on Senior Scholars Program Poster Presentation Day at the University of Massachusetts Medical School, Worcester, MA, on April 27, 2016.
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Copyright is held by the author(s), with all rights reserved.ae974a485f413a2113503eed53cd6c53
10.13028/t1we-dg27