What is the Prevalence of Occult Malignancy During Hysterectomy or Myomectomy for Benign Indications?
BACKGROUND AND PURPOSE:
Hysterectomy and myomectomy are common gynecologic surgeries, often done for benign conditions
Desai et al. (Obstet Gynecol, 2018) estimated the prevalence of occult uterine, cervical and ovarian malignancy in women undergoing hysterectomy or myomectomy for benign indications
Secondary analyses of data from American College of Surgeons National Surgical Quality Improvement Program (2014-2015)
Adult women undergoing hysterectomies and myomectomies without evidence of cancer were included in the analyses
Primary outcome was pathology-confirmed uterine, cervical and ovarian malignancy
Secondary outcome was that of stage of identified occult malignancies
Results were adjusted to account for confounders using logistic regression analysis
24,076 women underwent hysterectomy; 2,368 underwent myomectomy
For those women undergoing hysterectomy, prevalence of occult cancers were as follows
Uterine cancer: 1.44%
Cervical cancer: 0.60%
Ovarian cancer: 0.19%
The prevalence of uterine cancer varied depending on surgical procedure
Laparoscopic supracervical hysterectomy: 0.23%
Total laparoscopic or laparoscopic-assisted vaginal hysterectomy 1.89%
Older women were significantly more likely to have preoperatively undetected uterine malignancy when comparing women age ≥55 years vs age 40-54 years
Adjusted odds ratio 6.46; 95% CI, 4.96-8.41
Among patients undergoing myomectomy, 0.21% were found to have malignancy of the corpus uteri with no occult cervical or ovarian cancer identified
80% of uterine cancers and 60.9% of ovarian cancers were stage I-IC neoplasms
44.1% of cervical cancers were diagnosed at stage I-IB2 and 40.7% had stage ‘not otherwise specified’ (NOS)
Large and diverse patient population
Results provide additional information regarding the potential for malignancy with intracorporeal electromechanical morcellation
Prevalence varied based on patient age and surgical route
Prolapse may be associated with lower risk of malignancy
Surgeons may opt for complete removal of the uterus in women who may be at higher risk for malignancy, hence the higher risk of malignancy using this approach
The results indicate the importance of a thorough workup for malignancy in women who are 55 years of age or older
The ‘ACOG Statement on FDA Regulation of Morcellation’ (2015) states
As a result of the continuing conversation about morcellation, obstetrician-gynecologists are better able to evaluate each individual woman’s risk of an undiagnosed sarcoma, and to counsel her to receive the right approach for her own unique medical needs.
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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