Histopathology and Clinical Outcomes of 151 Women with Postmenopausal Bleeding Treated with Resectoscopic Surgery
| Autor: | Angelos G. Vilos, H Abduljabar, George A. Vilos, A. Oraif, Rakia AlJasser, Basim Abu-Rafea |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Gynecology
medicine.medical_specialty 030219 obstetrics & reproductive medicine Hysterectomy medicine.diagnostic_test business.industry medicine.medical_treatment Endometrial cancer Obstetrics and Gynecology Retrospective cohort study medicine.disease Atypical hyperplasia Endometrial hyperplasia 03 medical and health sciences 0302 clinical medicine 030220 oncology & carcinogenesis Biopsy medicine Histopathology business Endometrial biopsy |
| Zdroj: | Journal of Minimally Invasive Gynecology. 27:763-773 |
| ISSN: | 1553-4650 |
| DOI: | 10.1016/j.jmig.2019.06.004 |
| Popis: | Study Objective Because postmenopausal bleeding (PMB) is associated with up to 10% of endometrial neoplasia and office endometrial sampling fails in approximately 10% and is inadequate in 30% of cases, the objective was to determine the role of hysteroscopic endometrial resection (HER) for the diagnosis and treatment of women with PMB. Design A retrospective cohort. Setting A university-affiliated teaching hospital. Patients One hundred fifty-one women with PMB (September 1990–December 2010). Intervention HER in the operating room. Measurements and Main Results The median (range) age and body mass index were 58 (50–87) years and 29 (21–52) kg/m2, respectively. Office endometrial biopsy failed in 30 (19.8%), was inadequate in 20 (13.2%), identified nonatypical endometrial hyperplasia (NAH) in 21 (14%), atypical hyperplasia (AH) in 4 (2.6%), and endometrial cancer (EC) in 2 (1.3%) women. HER in 151 women identified 7 new cases of AH (3 from failed/inadequate office biopsy and 4 from NAH) and 9 EC (5 from failed/inadequate office biopsy, 1 from proliferative endometrium, 2 from NAH, and 1 from AH). All 27 women with NAH were treated by HER alone. Of 8 women with AH, 6 were treated with HER and 2 with hysterectomy; no residual endometrium was found in hysterectomy specimens. Of the 11 women with EC, 2 refused hysterectomy and are well 10 and 15 years after HER. Hysterectomy was performed for 9 of 11 EC cases, 2 of 8 AH cases, and 1 for abnormal uterine bleeding. Six women had repeat HER for persistent abnormal uterine bleeding, and 10 were lost to follow-up. At a median follow-up of 11.5 years (range, 7–20 years), 132 (12 hysterectomies + 10 lost) of 151 (87.4%) women were satisfied with no further bleeding. Conclusion In women with PMB, hysteroscopic endometrial resection concomitantly with resection of intrauterine pathology by experienced surgeons is feasible, safe, and effective for diagnosis in all cases and treatment of the majority of intrauterine pathology including NAH and selected cases of AH and EC. |
| Databáze: | OpenAIRE |
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