Dilatation and curettage fails to detect most focal lesions in the uterine cavity in women with postmenopausal bleeding.

Abstract

OBJECTIVE:

To determine the prevalence of focally growing lesions in the uterine cavity in women with postmenopausal bleeding and endometrium > or = 5 mm and the extent to which such lesions can be correctly diagnosed by D&C.

METHODS:

In a prospective study, 105 women with postmenopausal bleeding and endometrium > or = 5 mm at transvaginal ultrasound examination underwent diagnostic hysteroscopy, D&C and hysteroscopic resection of any focally growing lesion still left in the uterine cavity after D&C. Twenty-four women also underwent hysterectomy. If the histological diagnosis differed between specimens from the same patient, the most relevant diagnosis was considered the final one.

RESULTS:

Eighty percent (84/105) of the women had pathology in the uterine cavity, and 98% (82/84) of the pathological lesions manifested a focal growth pattern at hysteroscopy. In 87% of the women with focal lesions in the uterine cavity, the whole or parts of the lesion remained in situ after D&C. D&C missed 58% (25/43) of polyps, 50% (5/10) of hyperplasias, 60% (3/5) of complex atypical hyperplasias, and 11% (2/19) of endometrial cancers. The agreement between the D&C diagnosis and the final diagnosis was excellent (94%) in women without focally growing lesions at hysteroscopy.

CONCLUSION:

If there are focal lesions in the uterine cavity, hysteroscopy with endometrial resection is superior to D&C for obtaining a representative endometrial sample in women with postmenopausal bleeding and endometrium > or = 5 mm.

• Authors: E Epstein, A Ramirez, L Skoog, L Valentin
• Journal: Acta obstetricia et gynecologica Scandinavica (Acta Obstet Gynecol Scand) Vol. 80 Issue 12 Pg. 1131-6 (Dec 2001) ISSN: 0001-6349 [Print] United States
• PMID: 11846711 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Aged, 80 and over
• Dilatation and Curettage
• Endometrial Neoplasms (diagnosis, pathology, surgery)
• Female
• Humans
• Hyperplasia (diagnosis, surgery)
• Hysteroscopy
• Middle Aged
• Polyps (diagnosis, surgery)
• Postmenopause
• Prospective Studies
• Uterine Hemorrhage (diagnosis, pathology, surgery)