Danish medical journal · 2022
Diagnostic delay of gynaecological cancer in women with postmenopausal bleeding.
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Elmstrøm-Christensen Laura Benedikte, Lauszus Finn Friis
Аннотация
INTRODUCTION: Postmenopausal bleeding is the primary reason for referral to the gynaecological fast-track suspected cancer programme due to an elevated risk of endometrial cancer. The aim of this study was to examine the diagnostic flow among women with postmenopausal bleeding.
METHODS: Data were collected and analysed from 362 women at Sygehus Sønderjylland referred with the International Classification of Diseases, tenth edition, diagnosis "DN950 postmenopausal bleeding" from 2015 to 2019.
RESULTS: We found a mean 83-day period between the initial consultation and the final cancer diagnosis. Combined, the 362 women underwent 354 diagnostic procedures of which 204 were endometrial sampling with aspiration (vabrasio). In 44% of the cases, sampling by vacuum aspirator was either unsuccessful due to pain or cervical stenosis or was deemed insufficient for pathological assessment. Gynaecological cancer was diagnosed in 16 (4%) of the women, hereof 13 (3.6%) had endometrial cancer.
CONCLUSIONS: We found a remarkable delay not complying with the intentions of national guidelines with respect to final diagnostics of endometrial cancer. Vacuum aspirator is a frequently used diagnostic tool, but has shortcomings in relation to the success rate of the procedure and insufficient sampling. Gynaecological cancer was found at a rate of 3-5% as reported by other Danish studies. Because of the limitations associated with a one-step diagnostic procedure with vabrasio, attention to follow-up may reduce diagnostic delay.
FUNDING: none.
TRIAL REGISTRATION: This study was registered with the Region of South Denmark (no. 21/18387) and Sygehus Sønderjylland (no. 1298-001) as a quality improvement project.
METHODS: Data were collected and analysed from 362 women at Sygehus Sønderjylland referred with the International Classification of Diseases, tenth edition, diagnosis "DN950 postmenopausal bleeding" from 2015 to 2019.
RESULTS: We found a mean 83-day period between the initial consultation and the final cancer diagnosis. Combined, the 362 women underwent 354 diagnostic procedures of which 204 were endometrial sampling with aspiration (vabrasio). In 44% of the cases, sampling by vacuum aspirator was either unsuccessful due to pain or cervical stenosis or was deemed insufficient for pathological assessment. Gynaecological cancer was diagnosed in 16 (4%) of the women, hereof 13 (3.6%) had endometrial cancer.
CONCLUSIONS: We found a remarkable delay not complying with the intentions of national guidelines with respect to final diagnostics of endometrial cancer. Vacuum aspirator is a frequently used diagnostic tool, but has shortcomings in relation to the success rate of the procedure and insufficient sampling. Gynaecological cancer was found at a rate of 3-5% as reported by other Danish studies. Because of the limitations associated with a one-step diagnostic procedure with vabrasio, attention to follow-up may reduce diagnostic delay.
FUNDING: none.
TRIAL REGISTRATION: This study was registered with the Region of South Denmark (no. 21/18387) and Sygehus Sønderjylland (no. 1298-001) as a quality improvement project.