58 Rates of unanticipated pathology at the time of hysterectomy performed for pelvic organ prolapse in an underscreened population: An observational cohort study

Abstract

To describe the rates of unanticipated pathology at the time of hysterectomy performed for pelvic organ prolapse in an underscreened population. A secondary objective was to determine risk factors for unanticipated pathology. Hysterectomies performed for pelvic organ prolapse at a large public hospital between July 2007 and July 2019 were reviewed. Patients undergoing surgery for malignancy or atypical hyperplasia were excluded. Medical records were reviewed for demographic information, medical history, pre-operative work up, and final pathology. Frequencies of abnormal pathologies were calculated. Demographic and screening factors were correlated with pathologic findings by Fisher’s exact test or Mann-Whitney U test, as appropriate. This study was IRB approved. Between 2007 and 2019, 759 patient cases were identified. Most patients self-identified as Hispanic (87.9 %). The median age was 57 years old and 66.5 % of patients were post-menopausal. Abnormal uterine bleeding history was present in 28.6 % of patients. The majority of patients underwent preoperative ultrasonography (65.4 %) and 38.3 % underwent preoperative endometrial biopsy. Of the 744 uterine specimens that had available histology results, there were two cases of endometrial hyperplasia and one case of endometrial cancer. Of the 729 cervical specimens that were available for review, there was one case of intraepithelial neoplasia and two cases of cervical cancer. In the 246 patients who underwent oophorectomy, no ovarian malignancies were found. Those with endometrial hyperplasia or endometrial cancer were younger than those with benign findings (P=0.05) and had a thicker endometrium on ultrasound (P=0.024). Two of the three patients who had abnormal endometrial findings at the time of hysterectomy had benign pre-operative endometrial biopsies. There were no demographic or preoperative findings that were significantly different between patients with abnormal cervical pathology and benign cervical findings (all P>0.05). For patients undergoing hysterectomy for pelvic organ prolapse in a public hospital setting, the rates of endometrial dysplasia or cancer were 0.4% and the rates of cervical dysplasia or cancer were 0.4%. Given that this medically under screened population underwent appropriate perioperative evaluation, these results underscore the importance of considering screening history when interpreting perioperative diagnostic results.View Large Image Figure ViewerDownload Hi-res image Download (PPT)