Comparison of the postoperative premaligin / maligin pathology results of preoperative endometrium sampling in patients with hysterectomy by benign indications

Introduction and Aim: Hysterectomy is the second most common gynecological surgical operation worldwide after cesarean section. Although it is usually done with benign indications, the necessity of endometrial sampling to rule out possible malignancy is controversial. In our study, we aimed to investigate whether routine administration should be performed before benign indication hysterectomy because the fact that endometrial sampling is an invasive procedure, high false negative results, serious complications such as infection, bleeding and perforation, and additional risk of anesthesia and loss of labor. Material and Method: The demographic and clinical features, preoperative and postoperative endometrial pathology results of 934 patients who underwent hysterectomy due to endometrial hyperplasia and benign indications between January 2009 and December 2019 were evaluated retrospectively. These patients were divided into postmenopausal (1 year amenorrheic) and premenopausal (other) patients according to menopausal status. Then, patients who were asymptomatic (without abnormal uterine bleeding or postmenopausal bleeding) and no abnormal ultrasound findings were discussed. Next these patients were divided according to whether preoperative endometrial sampling was performed. These patients included in our study were examined in a total of 4 separate groups. The demographic characteristics and final pathology of the patients in the groups compared the premalign / malignant lesion rate. In addition, premalignant and malignant pathology rates of patients who underwent hysterectomy due to myoma uteri were calculated in these groups. Results: Of the 934 patients included in the study, 399 were in postmenopausal and 535 were in premenopausal period. Among the patients in the postmenopausal period, there were 157 patients who were asymptomatic (without abnormal uterine bleeding or postmenopausal bleeding) and no abnormal ultrasound findings in terms of clinical endometrial pathology,which was 24 cases with biopsy (group 1) and 133 cases without (group 2). As a result of the final pathology of the patients in group 1, 1 of them had without atypical EH, 2 of them had atypical EH, and 6 of them had endometrial cancer. In group 2, there were 18 patients without atypical EH, 15 patients with atypical EH and 30 patients with endometrial cancer. These last three parameters were combined and compared. The rates of hysterectomy results observed in the groups were similar. No significant differences were observed in the final pathology results depending on the groups (p> 0.05). Among the patients in the premenopausal period, 221 patients without asymptomatic and understood ultrasound findings were evaluated as 42 patients with biopsy (group 3) and 179 patients without (4 group). In group 3, 2 patients without EH and 1 with endometrium CA were observed, and no patients with EH. In Group 4, 2 atypical EH and 3 patients had endometrial cancer. No atypical EH was observed in this group. No statistically significant results were obtained in the hysterectomy results of these two groups of patients (p> 0.05). Among the indications of hysterectomy, especially myoma uteri and other benign (prolapse, TOA, adnexal mass, etc.) of the patients we evaluated in 4 groups and examined. The patients with myoma uteri indications had no any endometrial premalignant or malignant pathology. Incidental cancer rate was found to be 1.05% (n: 40) in 378 patients examined in 4 groups. Conclusion: Routine endometrial biopsy does not appear to be effective in patients who are planned hysterectomy with benign indications. Especially in these patients in the postmenopausal period, incidental cancer is detected but it is not statistically significant. Keywords: Benign, Dilatation & Curettage, Endometrial sampling, Hysterectomy