Sabt Fatema Y, Isa Hasan M, Khudair Zahra A, Khedr Enjy E, Alkhan Fatema A, Hammad Jumana S
Department of Obstetrics and Gynecology, Salmaniya Medical Complex, Manama, BHR.
Department of Pediatrics, Arabian Gulf University, Manama, BHR.
Cureus. 2024 Aug 14;16(8):e66880. doi: 10.7759/cureus.66880. eCollection 2024 Aug.
Introduction Detection of gynecological cancers preoperatively is imperative for practitioners for optimal patient management and outcome. This study aimed to estimate the incidence of unexpected malignancy (UM) in patients who underwent hysterectomy or myomectomy for presumed benign indications and to detect the predictive factors of UM. Methods A retrospective analytical study that included patients who underwent hysterectomy or myomectomy for benign indications from January 1st, 2016, to December 31st, 2020, was conducted at the Department of Obstetrics and Gynecology at Salmaniya Medical Complex, Bahrain. The main outcome was the overall incidence of UM and the incidence of each malignancy. Characteristics of UM were compared with benign pathologies. Fisher's exact and Pearson's chi-square tests were used to compare categorical variables and the Mann-Whitney U test or student's t-test for continuous variables. Binary logistic regression was used to identify the predictors of occurrence of UM. Confidence interval (CI) was set at 95%. A probability value (p-value) less than 0.05 was considered statistically significant. Results Out of 513 patients who underwent hysterectomy or myomectomy, 379 (73.9%) fulfilled the inclusion criteria, 314 (82.8%) hysterectomies and 65 (17.2%) myomectomies. The overall incidence of UM was 1.3% (n=5/379), 1.3% (n=4/314) among hysterectomies and 1.5% (n=1/65) among myomectomies. Three (0.8%) pre-malignant pathologies were identified: one (0.26%) smooth muscle tumor of unknown malignant potential, leiomyoma with bizarre nuclei, and mucinous borderline tumor of endocervical type of ovary each. The types of UM were sarcomas in three (0.26%) patients (two (0.5%) leiomyosarcoma and one (0.26%) endometrial stromal sarcoma) and endometrial adenocarcinoma and ovarian cancer in one (0.26%) patient each. No significant difference was found between the characteristics of UM and benign pathologies. Conclusion Although this study demonstrated a low incidence of UM among both hysterectomies and myomectomies, the age at the diagnosis of our patients with UM was as young as 34 years of age, and sarcomas were the most common type of UM. Disconcertingly, none of the studied independent variables had significantly predicted the occurrence of UM.
引言 术前检测妇科癌症对于从业者优化患者管理和改善预后至关重要。本研究旨在评估因假定为良性指征而接受子宫切除术或肌瘤切除术的患者中意外恶性肿瘤（UM）的发生率，并检测UM的预测因素。
方法 在巴林萨勒曼尼亚医疗中心妇产科进行了一项回顾性分析研究，纳入了2016年1月1日至2020年12月31日因良性指征接受子宫切除术或肌瘤切除术的患者。主要结局是UM的总体发生率以及每种恶性肿瘤的发生率。将UM的特征与良性病理进行比较。采用Fisher精确检验和Pearson卡方检验比较分类变量，采用Mann-Whitney U检验或学生t检验比较连续变量。采用二元逻辑回归确定UM发生的预测因素。设定95%的置信区间（CI）。概率值（p值）小于0.05被认为具有统计学意义。
结果 在513例行子宫切除术或肌瘤切除术的患者中，379例（73.9%）符合纳入标准，其中314例（82.8%）行子宫切除术，65例（17.2%）行肌瘤切除术。UM的总体发生率为1.3%（n = 5/379），子宫切除术中为1.3%（n = 4/314），肌瘤切除术中为1.5%（n = 1/65）。发现3例（0.8%）癌前病变：1例（0.26%）恶性潜能未知的平滑肌肿瘤、奇异核平滑肌瘤和宫颈内膜型卵巢黏液性交界性肿瘤各1例。UM的类型为3例（0.26%）患者为肉瘤（2例（0.5%）平滑肌肉瘤和1例（0.26%）子宫内膜间质肉瘤），1例（0.26%）患者为子宫内膜腺癌和卵巢癌各1例。UM的特征与良性病理之间未发现显著差异。
结论 尽管本研究表明子宫切除术和肌瘤切除术中UM的发生率较低，但我们诊断为UM的患者年龄小至34岁，肉瘤是最常见的UM类型。令人不安的是，所研究的独立变量均未显著预测UM的发生。
