Study Identifies Prevalence of Uterine Malignancy and Endometrial Hyperplasia at Time of Morcellation for Hysterectomy
There is considerable concern that uterine morcellation as part of minimally invasive hysterectomy may result in the spread of undetected malignancies. In a study reported in JAMA, Wright et al identified a prevalence of 27 cases of uterine cancer and 7 cases of other gynecologic malignancies per 10,000 women undergoing morcellation.
Study Details
In the study, data from a large insurance database (Perspective) were used to identify 36,470 women (15.7%) who underwent morcellation from among 232,882 women who underwent minimally invasive hysterectomy between 2006 and 2012. Hospitals in the database are more frequently urban teaching centers and located in the southern United States.
Malignancies and Hyperplasia
Among women who underwent morcellation, there were 99 cases of uterine cancer, a prevalence of 27/10,000 (95% confidence interval [CI] = 22–32/10,000) and 26 cases of other gynecologic malignancies, a prevalence of 7/10,000 (95% CI = 4–10/10,000). In addition, 39 cases of uterine neoplasm of uncertain malignant potential (prevalence of 11/10,000, 95% CI = 7–14/10,000) and 368 cases of endometrial hyperplasia (prevalence of 101/10,000, 95% CI = 91–111/10,000) were identified.
Effect of Age
Compared with women aged > 40 years, significantly increased prevalence ratios (P < .05) for both uterine cancer and endometrial hyperplasia were observed in those aged 45 to 49 years (2.55 and 1.71), 50 to 54 years (4.97 and 4.07), 55 to 59 years (19.37 and 8.22), 60 to 64 years (21.36 and 9.38), and ≥ 65 years (35.97 and 10.21). Black women had a lower uterine cancer prevalence ratio vs white women (0.34) and single women had a higher ratio than married women (1.58, both P < .05).
The investigators noted, “Prevalence information is the first step in determining the risk of spreading cancer with morcellation…. [W]e lack data on long-term follow-up, and the outcome of women with pathological abnormalities who underwent morcellation requires further study. Patients considering morcellation should be adequately counseled about the prevalence of cancerous and precancerous conditions prior to undergoing the procedure.”
Jason D. Wright, MD, of Columbia University College of Physicians and Surgeons, is the corresponding author for the JAMA article.
The study was supported by the National Cancer Institute. The study authors reported no potential conflicts of interest.
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