Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey.
Department Obstetrics and Gynecology, Medicalpark Maltepe Hospital, Istanbul, Turkey.
J Obstet Gynaecol. 2021 Feb;41(2):298-304. doi: 10.1080/01443615.2020.1833849. Epub 2021 Jan 15.
The aim of the present study was to determine the incidence of unexpected gynaecological malignancies in patients undergoing hysterectomy for benign indications and to evaluate their clinical characteristics. Data from 6448 cases who had undergone hysterectomy for benign indications between the dates of 01.01.2008-01.01.2018 were recorded retrospectively from the database of the institution. The mean age of the cases with malignancy was 59.2 ± 9.66 (45-80) and 76,31% were (29/38) postmenopausal. The mean gravidity was 3.94 ± 1.73 and parity was 3.31 ± 1.45. Their mean BMI was 29.6 ± 4.26 kg/m (22.4-41.9 kg/m range). These patients were followed for a mean duration of 60.68 ± 37.66 months and during this period death associated with malignancy occurred in 4/38 (%10.52) cases, all of whom had leiomyosarcoma. The benign indications of procedure were as follows: myoma uteri (2675, 41.48%), abnormal uterine bleeding (1508, 23.38%), uterine prolapsus (793, 12.29%), ovarian cyst (619, 9.59%), endometriosis (303, 4.69%), endometrial polyp (264, 4.09%), pelvic pain (238, 3.69%) and other benign causes (48, 0.74%). Unexpected gynaecological malignancy was found in 20 cases (0.31%) with endometrial cancer, in eight cases (0.12%) with uterine sarcoma, in seven cases (0.10%) with ovarian cancer, in one case (0.01%) with tubal cancer and in two (0.03%) with cervical cancer. Gynaecological malignancy was found in 38 of 6648 cases who underwent hysterectomy for benign indications, yielding an incidence rate of 0.58%.IMPACT STATEMENT Hysterectomy is the most common gynaecological surgery in the world and although most are performed for benign indications, unexpected gynaecological malignancy is possible in the final pathology results.Although there are available publications investigating unexpected gynaecological malignancy incidences after hysterectomies for benign reasons, the incidence is still not clear. We aimed to contribute to the existing literature with this study, which includes a large number of cases. Our study adds new findings to the body of the knowledge on the incidence of unexpected gynaecological malignancies in hysterectomies for benign indications. Gynaecological malignancy was found in 38 of 6648 cases who underwent hysterectomy for benign indications, yielding an incidence rate of 0.58%. There is an unexpected possibility of gynaecological malignancy even in cases where it is expected to be benign with current diagnostic methods. In cases that are expected to be benign, detailed preoperative evaluation should be performed in all patients to prevent unexpected gynaecological malignancies. More sensitive screening methods should be developed especially in the preoperative differential diagnosis of leiomyoma and leiomyosarcoma.
本研究旨在确定因良性指征行子宫切除术患者中意外妇科恶性肿瘤的发生率，并评估其临床特征。从机构数据库中回顾性记录了 2008 年 1 月 1 日至 2018 年 1 月 1 日期间因良性指征接受子宫切除术的 6448 例患者的数据。恶性肿瘤患者的平均年龄为 59.2±9.66（45-80）岁，76.31%（29/38）为绝经后。平均孕次为 3.94±1.73，产次为 3.31±1.45。他们的平均 BMI 为 29.6±4.26kg/m（22.4-41.9kg/m 范围）。这些患者的中位随访时间为 60.68±37.66 个月，在此期间，4/38（10.52%）例患者因恶性肿瘤相关死亡，均为平滑肌肉瘤。手术的良性指征如下：子宫肌瘤（2675，41.48%）、异常子宫出血（1508，23.38%）、子宫脱垂（793，12.29%）、卵巢囊肿（619，9.59%）、子宫内膜异位症（303，4.69%）、子宫内膜息肉（264，4.09%）、盆腔痛（238，3.69%）和其他良性原因（48，0.74%）。意外发现妇科恶性肿瘤 20 例（0.31%），其中子宫内膜癌 8 例（0.12%），子宫肉瘤 7 例（0.10%），卵巢癌 1 例（0.01%），输卵管癌 1 例（0.01%），宫颈癌 2 例（0.03%）。因良性指征行子宫切除术的 6648 例患者中发现妇科恶性肿瘤 38 例，发生率为 0.58%。
陈述：子宫切除术是全世界最常见的妇科手术，尽管大多数手术都是为了良性指征，但最终的病理结果仍可能存在意外的妇科恶性肿瘤。虽然有一些关于良性原因子宫切除术后意外妇科恶性肿瘤发生率的已有文献，但发病率仍不清楚。我们的研究目的是通过这项包括大量病例的研究，为现有文献做出贡献。我们的研究为良性指征子宫切除术的意外妇科恶性肿瘤发生率提供了新的发现。因良性指征行子宫切除术的 6648 例患者中发现妇科恶性肿瘤 38 例，发生率为 0.58%。即使使用当前的诊断方法，预计良性的病例也存在意外发生妇科恶性肿瘤的可能性。对于预计良性的病例，应在所有患者中进行详细的术前评估，以预防意外的妇科恶性肿瘤。应特别开发更敏感的筛查方法，尤其是在子宫肌瘤和平滑肌肉瘤的术前鉴别诊断中。
