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Am J Obstet Gynecol. 2019 Mar 7. pii: S0002-9378(19)30430-2. doi: 10.1016/j.ajog.2019.02.051. [Epub ahead of print]

Prevalence, characteristics, and risk factors of occult uterine cancer in presumed benign hysterectomy.

Author information

1
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT; CooperSurgical Inc, Trumbull, CT.
2
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY.
3
Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Yale Cancer Outcomes, Public Policy and Effectiveness Research Center, New Haven, CT.
4
Department of Biostatistics, Yale School of Public Health, New Haven, CT.
5
New York State Cancer Registry, New York State Department of Health, Albany, NY.
6
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT.
7
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT; Yale Cancer Outcomes, Public Policy and Effectiveness Research Center, New Haven, CT. Electronic address: xiao.xu@yale.edu.

Abstract

BACKGROUND:

Occult uterine cancer at the time of benign hysterectomy poses unique challenges in patient care. There is large variability and uncertainty in estimated risk of occult uterine cancer in the literature and prior research often did not differentiate/include all subtypes.

OBJECTIVES:

To thoroughly examine the prevalence of occult uterine cancer in a large population-based sample of women undergoing hysterectomy for presumed benign indications and to identify associated risk factors.

STUDY DESIGN:

Using the New York Statewide Planning and Research Cooperative System database, we identified 229,536 adult women who underwent an inpatient or outpatient hysterectomy for benign indications during the period October 1, 2003 to December 31, 2013 at civilian hospitals and ambulatory surgery centers throughout the state. Diagnosis of corpus uteri cancer within 28 days after the index hysterectomy was determined using linked state cancer registry data. We estimated the prevalence of occult uterine cancer (overall and by subtype) and developed and validated risk prediction models using a random split sample approach.

RESULTS:

Overall, 0.96% (95% confidence interval: 0.92-1.00%) of the women had occult uterine cancer, including 0.75% (95% confidence interval: 0.71-0.78%) with endometrial carcinoma and 0.22% (95% confidence interval: 0.20-0.23%) with uterine sarcoma. The prevalence of leiomyosarcoma was 0.15% (95% confidence interval: 0.13-0.17%). Seventy-one percent of the endometrial carcinomas and 58.0% of the uterine sarcomas were at localized stage. The risk for occult uterine cancer ranged from 0.10% in women aged 18-29 years to 4.40% in women aged ≥75 years; and varied from 0.14% in women undergoing hysterectomy for endometriosis to 0.62% for uterine fibroids and 8.43% for postmenopausal bleeding. The risk of occult uterine cancer was also significantly associated with race/ethnicity, obesity, comorbidity, and personal history of malignancy. Prediction models incorporating these risk factors had high negative predictive values (99.8% for endometrial carcinoma and 99.9% for uterine sarcoma) and good rule-out accuracy despite low positive predictive value.

CONCLUSIONS:

In women undergoing hysterectomy for presumed benign indications, 0.96% had unexpected uterine cancer. Patient characteristics such as age, surgical indication, and medical history may help guide risk stratification.

KEYWORDS:

endometrial carcinoma; hysterectomy; leiomyosarcoma; occult uterine cancer; risk prediction; uterine sarcoma

PMID:
30853364
DOI:
10.1016/j.ajog.2019.02.051

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