DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20210745

Prevalence of occult gynecological cancer in women undergoing surgeries for benign indications in a tertiary healthcare center of Chhattisgarh

Abha Singh, Avinashi Kujur, Renuka Gahine, Rashmi Tiwari

Abstract


Background: Hysterectomy, the surgical removal of uterus, is 2nd most frequently performed major surgical procedures on women,with90% of hysterectomies are performed for benign indications. However, there may be cases in which malignancy or premalignant lesions which are only confirmed on histopathology are defined as occult malignancy.

Methods: We conducted a prospective observational study on a cohort of women undergoing various gynaecological surgeries for benign indications in a time period of January 2019 to January 2020 in the Department of obstetrics and gynaecology, Dr. BRAM hospital and Pt. J. N. M. medical college, Raipur (C.G) to find out the prevalence of occult pre malignant and malignant lesions.

Results: Of 132 women who underwent surgeries for benign gynecological indications, based on final histopathological report, prevalence of occult premalignant lesion was 11.36% (95% CI 5.7-16.3%) and prevalence of occult malignancy was 2.27% (95% CI 0.2 -4.8%). Prevalence of occult premalignant lesion of corpus uteri and cervix uteri was 2.3 and 9.1% respectively. No occult premalignant lesion of ovary was found. Prevalence of occult malignant lesion of corpus uteri and ovary was 1.5 and 0.75% respectively.

Conclusions: We observed that even after complete preoperative workup only 72.7% of the preoperative clinical diagnoses were correlated with their histopathological diagnosis. Thus, while making the diagnosis, risk factors along with standard preoperative approach should be strongly adhered to prevent misdiagnosis and to prevent missing of any pre malignant or malignant findings. 


Keywords


Benign indications, Hysterectomy, Myomectomy, Occult malignancies, Risk factors

Full Text:

PDF

References


Whiteman MK, Hillis SD, Jamieson DJ, Morrow B, Podgornik MN, Brett KM et al. Inpatient hysterectomy surveillance in the United States, 2000-2004. Obstet Gynecol. 2008;34.e1-7.

Desai VB, Wright JD, Schwartz PE, Jorgensen EM, Fan L, Litkouhi B et al. Occult Gynecologic Cancer in Women Undergoing Hysterectomy or Myomectomy for Benign Indications. Obstetr Gynecol. 2018;131(4):642-51.

Kho KA, Lin K, Hechanova M, Richardson DL. Risk of occult uterine sarcoma in women undergoing hysterectomy for benign indications. Obstetr Gynecol. 2016;127(3)468-73.

Ramachandran T, Sinha P, Subramanium. Correlation between Clinico-Pathological and Ultrasonographical findings in hysterectomy. J clin diag res. 2011;5(4):737-40.

Dhruw D, Chikhlikar K, Meshram A. Analysis of the Histopathological examination of lesions in hysterectomy specimens in a tertiary care hospital: A five-year study. J Dental Med Sci. 2019;18(4):31-9.

Frick AC, Walters MD, Larkin KS, Barber MD. Risk of unanticipated abnormal gynecologic pathology at the time of hysterectomy for uterovaginal prolapse. Am J Obstet Gynecol. 2010;202:507.e1-4.

Rather GR, Gupta Y, Bharhwaj S. Patterns of lesions in hysterectomy specimen: A prospective study. Department of pathology Govt. Medical College, Jammu. JK sci. 2013;15(2):63-8.

Mahnert N, Morgan D, Campbell D, Jhonston C, As-Sanie S. Unexpected gynecological malignancy diagnosed after hysterectomy performed for benign indications. Obstet Gynecol. 2015;125(2):397-405.

Sawke NG, Sawke GK, Jain H. Histopathology findings in patients presenting with menorrhagia: A study of 100 hysterectomy specimen. J Midlife Health. 2015;6(4):160-3.

Singh P, Ticku A, Jamwal G. Histopathological Spectrum of Hysterectomy Specimens in Tertiary care hospital: A Prospective Study. 2017;4(8):858-66.

Singh A, Arora AK. Why hysterectomy rate are lower in India? Indian J Community Med. 2008;33(3)196-7.

Wright JD, Desai VB, Gross CP, Hutchinson LM, Schwartz PE, Xu X. Prevalence, Characteristics and Risk factors of occult uterine cancer in presumed benign hysterectomy. Am J Obstetr Gynecol. 2019;221:39.e1-14.

Singh A, Bansal S. Vaginal hysterectomy for non-prolapsed uterus. J Obstet Gynecol India. 2006;56(2):152-5.

Seles FM, Indira R. Incidental gynecological malignancy in women who underwent hysterectomy for utero-vaginal prolapse: a 3-year institutional study. Int J Reprod Contracept Obstet Gynecol. 2018;7(9):3625-28.

Parker WH. Ovarian conservation versus Bilateral oophorectomy at the time of hysterectomy for benign disease. 2013;1-4.

Parker WH, Broder MS, Liu Z, Shoupe D, Farquhar C, Berek JS. Ovarian Conservation at the Time of Hysterectomy for Benign disease. Obstet Gynecol. 2005;106(2):219-26.

Shuster LT, Gostout BS. Grossardt BR, Rocca WA. Prophylactic Oophorectomy in Premenopausal Women and long-term health. Menopause Int. 2008;14(3):111-6.

Parker W. Elective oophorectomy in the gynecological patients: When is it desirable? Curr. Opin. Obstet and Gynecol. 2007;350-54.

Khan R, Sultan H. How does histopathology correlate with clinical and operative findings in abdominal hysterectomy? JAFMC Bangladesh. 2010;6(2):17-20.

Ebinesh A, Sharada MS, Krishna MC. Clinico- pathological correlation of abdominal hysterectomy specimens. Int J Sci Res. 2015;4(6).

Lilac G, Zivandinvio R, Petric A, Lilac V. Preoperative preparation of patients for gynecologic surgery. Sci J Faculty Med Nis. 2011;28(2):125-33.

Markham SM, Rock JA. Preoperative care. In: Rock JA, Johnes HW, eds. Te Linde’s operative gynecology. 9th ed. Philadelphia: Lippincott Williamse Wilkins. 2003;475-7.