Occult Uterine Malignancy at the Time of Surgery for Benign Gynecologic Indications: An Updated Systematic Review

Abstract

Study Objective To conduct an updated systematic review to estimate the prevalence of occult uterine malignancy, of any subtype, among women undergoing surgery for benign gynecologic conditions. Design Systematic review. Setting N/A Patients or Participants Women undergoing surgery for presumed benign gynecologic conditions. Interventions Hysterectomy or Myomectomy. Measurements and Main Results The PRISMA guidelines were followed in this systematic review. The search terms used were “occult malignancy” or “occult uterine pathology” paired with “morcellation” or “hysterectomy.” March 25, 2019 was the last date that articles were searched. We did not restrict articles based on language or publication date. Inclusion criteria included any peer-reviewed journal articles reporting occult uterine malignancy rates at the time of surgery for benign conditions, regardless of whether morcellation was used or not. We excluded articles that were reported exclusively on women with pre-operatively diagnosed or suspected uterine malignancies. Our search yielded a total of 233 journal articles, of which 53 met the criteria for a full-text review and 27 were included in the final systematic review. There were 339,420 patients across 9 countries that were included in these 27 studies. As a comparison, the previous systematic review done by the Agency for Healthcare Research and Quality (AHRQ) only included a total of 136,195 patients. There were a total 2,479 occult uterine malignancies (all subtypes combined) among these 339,420 patients. The crude unadjusted occult uterine malignancy rate was 0.73% (95% CI 0.70 – 0.76%). When we examined a subset of the included studies that reported specific data on women undergoing morcellation, there were 82 occult malignancies among a total of 25,422 patients (Crude proportion = 0.32% [95% CI 0.25 – 0.39%]). Conclusion Based on this systematic review, incorporating over 300,000 patients, the overall prevalence of occult uterine malignancy at the time of surgery for benign gynecologic indications is approximately 0.73%.