[Analysis of indications and results of fractional curettage in a large gynecological cohort].
OBJECTIVE
To determine whether the term "fractional D&C" is justified with respect to the uterine cervix and corpus fractions, and what indications and results are found when a large population at a university hospital is analyzed.


METHODS
In this retrospective study covering a 3-year period at the Department of Gynecology, University Hospital of Zurich, indications and results of fractional D&C were obtained from hospital records stored in a data bank. The curettage results of hysterectomized women were compared with the histological findings of the hysterectomy specimens.


RESULTS
938 women (mean age 52 years) underwent fractional D&C. 38% had postmenopausal, 36% premenopausal and 13% perimenopausal abnormal bleeding. For 5% there was a sonographic finding without bleeding disorders, 4% had cervical polyps, 1% breast cancer, and 3% other diagnoses. In 13% of the cases the corpus curettage material could not be evaluated. For 43%, the corpus material appeared normal and in 5% a malignancy was found. In 74% of the cervical fractions nothing abnormal was detected, in 14% no conclusive evaluation of the material was possible, and in 3% the histological report showed a malignancy. In 20% of the cases the cervix curettage material was contaminated with material from the uterus cavum.


CONCLUSIONS
For cases with cancer of the cervix, the sensitivity of fractional D&C was 80%, compared with a specificity of 66.7%. With a positive predictive value of 52.2%, the term "fractional D&C" is in many cases not justified. Our data and recent literature have prompted us to draw up new criteria for evaluation of abnormal vaginal bleeding, or a new set of indications for fractional D&C and hysteroscopy.
Köchli
O R
OR
Departement Frauenheilkunde, Universitätsspital Zürich.
Schär
G N
GN
Bajka
M
M
Pók Lundquist
J
J
Nussbaumer
R
R
Keller
P J
PJ
Haller
U
U
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D004107:Dilatation and Curettage / Q000379:methods*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008599:Menstruation Disturbances / Q000473:pathology; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000473:pathology; D014592:Uterine Hemorrhage / Q000175:diagnosis / Q000473:pathology*
Analyse der Indikationen und Resultate der fraktionierten Kürettage an einem grossen gynäkologischen Krankengut.