Dilatation and Curettage in the Evaluation of Abnormal Uterine Bleeding: Histopathologic Findings and the Cost/Benefit Relation - Revista Brasileira de Ginecologia e Obstetrícia
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(8):495-502
Purpose: to critically evaluate the histopathologic findings and the cost/benefit relation of dilatation and uterine curettage (D&C) in the evaluation of the abnormal uterine bleeding (AUB). Method: retrospective analysis of the histopathological findings in 542 D&C performed for AUB in the Department of Gynecology of the Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), between January 1984 and January 1994. The patients were divided into two groups: Group 1 – patients <=50 years (385 D&C) and Group 2 -- patients >50 years (157 D&C). Cases of urgency curettage were excluded from the study. All the curettages were accomplished under narcosis. The mean hospitalization lenght was three days. A histopa-thological finding of proliferative, secretory, atrophic or iatrogenic type endometrium was considered a negative pathological result. The term iatrogenic refers to the endometrium under possible influence of hormonal medication. When the histopathological finding evidenced some lesion, this was considered a positive pathological result. Results: in Group 1 there was a negative pathological result in 50.2% of the cases, positive pathological result in 39.7% of the cases, and insufficient material for diagnosis (IMD) in 10.1% of the cases. Endometrial polyp and submucosal leiomyoma were found in only 5.5% and 4.4%, respectively. Cancer was an uncommon observation in that group, endometrial adenocarcinoma (EAC) (five cases) being found in only 1.3% of the cases, in a relation of 77 D&C to one EAC. In Group 2, a negative pathological result was observed in 38.3% of the cases, positive pathological result in 38.1% of the cases and IMD in 23.6% of the cases. Endometrial polyp and submucosal leiomyoma were found only in 5.1% and 0.6%, respectively. Malignant lesions were found in 12% of the cases EAC being 9.5% (15 cases), showing a relation of one EAC to 10 D&C. Conclusions: according to the current knowledge on the etiology of AUB, this study showed that traditional diagnostic D&C has low accuracy in the evaluation of AUB and a cost/benefit relation incompatible with current medicine. Therefore, it should not be the examination of first choice. Considering, however, that EAC was found in one of each 10 D&C in women >50 years with a complaint of uterine bleeding, D&C can be indicated with more liberality in that group, if hysteroscopy with directed biopsy is not available. Nowadays, D&C does not play such a significant a role in the diagnosis of AUB as it did some years ago. However, the procedure is still indicated in some situations and it cannot be abandoned, and its indication should obey restricted criteria.
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Purpose: to critically evaluate the histopathologic findings and the cost/benefit relation of dilatation and uterine curettage (D&C) in the evaluation of the abnormal uterine bleeding (AUB). Method: retrospective analysis of the histopathological findings in 542 D&C performed for AUB in the Department of Gynecology of the Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), between January 1984 and January 1994. The patients were divided into two groups: Group 1 - patients <=50 years (385 D&C) and Group 2 -- patients >50 years (157 D&C). Cases of urgency curettage were excluded from the study. All the curettages were accomplished under narcosis. The mean hospitalization lenght was three days. A histopa-thological finding of proliferative, secretory, atrophic or iatrogenic type endometrium was considered a negative pathological result. The term iatrogenic refers to the endometrium under possible influence of hormonal medication. When the histopathological finding evidenced some lesion, this was considered a positive pathological result. Results: in Group 1 there was a negative pathological result in 50.2% of the cases, positive pathological result in 39.7% of the cases, and insufficient material for diagnosis (IMD) in 10.1% of the cases. Endometrial polyp and submucosal leiomyoma were found in only 5.5% and 4.4%, respectively. Cancer was an uncommon observation in that group, endometrial adenocarcinoma (EAC) (five cases) being found in only 1.3% of the cases, in a relation of 77 D&C to one EAC. In Group 2, a negative pathological result was observed in 38.3% of the cases, positive pathological result in 38.1% of the cases and IMD in 23.6% of the cases. Endometrial polyp and submucosal leiomyoma were found only in 5.1% and 0.6%, respectively. Malignant lesions were found in 12% of the cases EAC being 9.5% (15 cases), showing a relation of one EAC to 10 D&C. Conclusions: according to the current knowledge on the etiology of AUB, this study showed that traditional diagnostic D&C has low accuracy in the evaluation of AUB and a cost/benefit relation incompatible with current medicine. Therefore, it should not be the examination of first choice. Considering, however, that EAC was found in one of each 10 D&C in women >50 years with a complaint of uterine bleeding, D&C can be indicated with more liberality in that group, if hysteroscopy with directed biopsy is not available. Nowadays, D&C does not play such a significant a role in the diagnosis of AUB as it did some years ago. However, the procedure is still indicated in some situations and it cannot be abandoned, and its indication should obey restricted criteria.
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