Predicting Gynecological Malignancy at Surgery: Magic 8 Ball, or Paradigm Shift?

Abstract

In medical school, future physicians are taught the phrase primum non nocere, first do no harm. That adage motivates every physician, every healthcare provider, to go to great lengths to avoid an incorrect diagnosis for a patient. As a gynecological surgeon, that adage is put to the test with every operative patient dealing with a pelvic mass. Encountering an undiagnosed malignancy during and anticipatedbenign surgical intervention is stressful for the surgeon, but devastating to the unprepared patient. Recently, attention has focused on uterine morcellation at time of laparoscopic hysterectomy. Stemming from the inadvertent morcellation of a leiomyosarcoma in a patient presumed to have been benign fibroids, the question has arisen of informed consent disclosures versus the appropriateness of a selected surgery when the possibility of a malignancy exists (WSJ Dec 2013).