Detection of endometrial carcinoma: clinical judgement versus histologic examination.
Dilatation and curettage (D&C) is routinely performed on patients with postmenopausal bleeding. The tendency is to rely on the results of the D&C rather than clinical judgment if the diagnosis is benign. In four of our patients treated with total abdominal hysterectomy, endometrial carcinoma was diagnosed even though earlier histologic examination with D&C had shown benign disease. All patients were 60 years of age or older. Three of the four patients had postmenopausal bleeding, and one patient had a Papanicolaou test that indicated an unexplained abnormality. All patients were obese (weighing more than 250 lb) and hypertensive. Other high-risk factors included diabetes mellitus in three and an elevated tumor marker antigen (CA125) in one. Frozen sections of tissue taken at D&C revealed no malignancy and failed to explain the postmenopausal bleeding. Rather than relying on these results, we assessed the high-risk factors and performed total abdominal hysterectomy immediately on all four patients. The results confirmed endometrial carcinoma. Immediate abdominal hysterectomy saved the patients additional anesthesia and delay in diagnosis.
Fiorica
J V
JV
Department of Obstetrics and Gynecology, University of South Florida, College of Medicine, Tampa.
Hoffman
M S
MS
Roberts
W S
WS
LaPolla
J P
JP
Cavanagh
D
D
D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D000368:Aged; D002983:Clinical Competence; D004107:Dilatation and Curettage; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008593:Menopause; D008875:Middle Aged; D012189:Retrospective Studies; D014592:Uterine Hemorrhage / Q000209:etiology; D014594:Uterine Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery