Risk of Occult Endometrial Cancer During Hysterectomy for Benign Indications [14H

Abstract

INTRODUCTION: Recent attention regarding the use of power morcellation highlighted concerns regarding occult uterine sarcomas. However, sarcomas comprise only 3% of uterine cancers. The vast majority of malignancies are endometrial in origin and are more reliably diagnosed preoperatively than sarcomas. We sought to estimate the frequency of occult endometrial cancer in women undergoing benign hysterectomies. METHODS: We performed a retrospective review of all patients undergoing hysterectomies for benign indications at our institution from 2006‒2014. A departmental database was used to identify all hysterectomies performed, and institutional tumor registry was used to identify cases of endometrial carcinoma. Occult carcinomas were defined as cases with no suspicion preoperatively and histopathologic diagnosis of endometrial cancer postoperatively. RESULTS: A total of 6,981 hysterectomies were performed. Thirteen patients (0.19%) were found to have occult endometrial cancer, with an overall rate of 1 in 537 patients (95% confidence interval 1:314‒1:1,008). Twelve patients had stage IA and one had stage IB disease. Median age of women with endometrial cancer was 50 years (range 35-72 years). The mean Body Mass Index was 32.6 ± 9.2 kg/m2. Most common indication for hysterectomy were abnormal bleeding (47%), then postmenopausal bleeding (15%). Cases included nine abdominal hysterectomies, two laparoscopic hysterectomies, and two vaginal hysterectomies. One specimen was manually morcellated during vaginal hysterectomy. CONCLUSION: This is one of the largest single institution cohorts to examine occult malignancy. Occult endometrial carcinomas are more common than occult uterine sarcomas, and were found to occur in 1:537 (0.19%) hysterectomies for benign indications in our population.