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EP455 Diagnostic hysterectomy for clinical suspicion of uterine cancer when histological confirmation is either not possible or inconsistent with clinical findings
  1. S Makrydima1,
  2. D Saragli2,
  3. M Wong3 and
  4. R Wuntakal4
  1. 1Clinical Fellow in Gynaecology Oncology
  2. 2Specialist Registrar in Obstetrics and Gynaecology
  3. 3Specialist Trainee in Obstetrics and Gynaecology
  4. 4Lead Consultant in Gynaecology Oncology Department, Queen's Hospital Romford, London, UK


Introduction/Background Traditionally, hysterectomy for endometrial cancer is performed following histological diagnosis. However, there are few cases where histology is impossible, inadequate or inconsistent with clinical findings/ symptoms. Therefore, even though the term ‘diagnostic hysterectomy’ is not used in literature, clinicians occasionally counsel patients regarding hysterectomy in the absence of abnormal histology, but in the presence of clinical suspicion of cancer. Our aim was to evaluate the need of diagnostic hysterectomy when all other diagnostic techniques have been inconclusive, but there is clinical suspicion of uterine cancer.

Methodology We have analysed all diagnostic hysterectomies (39) performed between 2016–2018 at a UK cancer unit because of clinical suspicion of uterine cancer. All cases were offered surgery following multidisciplinary team discussion.

Results Four categories of patients were included;

  1. Symptomatic patients (postmenopausal bleeding/ discharge/ irregular vaginal bleeding) where hysteroscopy was unsuccessful (20) or views were obscured (1),

  2. Symptomatic patients, where hysteroscopy was suspicious (4), although histology was negative or inadequate,

  3. Symptomatic patients with atrophic cavity on hysteroscopy or inadequate histology (12) and

  4. Asymptomatic patients with incidental finding of thickened endometrium and failed hysteroscopy (2).

Final histology revealed 11 (28%) cases of cancer; 6 endometrial cancers (4 endometrioid, 2 carcinosarcomas), 2 uterine sarcomas (1 leiomyosarcoma,1 rhabdomyosarcome), 2 fallopian tube carcinomas (1 mesothelioma, 1high grade serous carcinoma) and 1 sex cord stromal tumour of the ovary. We have to underline that 6 out of 11 cases (50%) were very aggressive with poor prognosis.

Conclusion Despite the advances of hysteroscopic techniques in the diagnosis of uterine cancer, there is still place for diagnostic hysterectomy when there is clinical suspicion of cancer and no definitive histology. For carefully selected cases, the cancer rate can be up to 30%, which justifies the necessity for intervention.

Disclosure Nothing to disclose.

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