[Little clinical relevance in routine pathological examination of uteri removed in women with prolapse symptoms].

OBJECTIVE

To study the clinical usefulness of pathological examination of the uteri removed from women with complaints of prolapse of the uterus.

DESIGN

Retrospective study.

SETTING

Department of Obstetrics and Gynaecology and Department of Pathology of the Medical Centre Alkmaar, the Netherlands.

METHODS

Between June 1st 1990 and August 31st 1994, 221 women underwent vaginal hysterectomy because of prolapse of the uterus. At the SIG Zorginformatie national reference data were collected from the pathology archives (PALGA).

RESULTS

No malignancy or carcinoma in situ of cervix or endometrium was found in the 221 women; 7 times a cervical intraepithelial neoplasia (CIN) 1 with free hysterectomy resection margins was seen. In the national data of 5,739 comparable operated women a malignancy was found in 9 (0.16%) patients while 10 (0.17%) specimens showed a carcinoma in situ; in one of these cases an adenocarcinoma of the endometrium had not been removed completely in the area of the fallopian tube. The unexpected finding of a cervical or uterine malignancy at histological examination is extremely rare (1:717 hysterectomies nationwide) if the uterus was surgically removed because of prolapse.

CONCLUSION

The idea of omitting histological examination under certain conditions needs further evaluation. A prospective study should ascertain under what circumstances, e.g. the combination of a normal menstrual bleeding pattern, or absence of postmenopausal bleeding, with a normal cervical smear preoperatively, and normal macroscopic appearance, judged by the pathologist, microscopic examination can safely be omitted.