Prevalence of histological abnormalities in hysterectomy specimens performed for prolapse. A systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: The practice of histopathological assessment of the uterus following hysterectomy for benign indications including pelvic organ prolapse (POP) surgery is common and often routine. While pathology is not anticipated, the finding of pathology requiring further action is always a concern, in particular CIN (cervical intraepithelial neoplasia) or cervical/uterine malignancy. We aimed to perform a systematic review to understand the prevalence of actionable uterine and cervical pathology in hysterectomy specimens performed for POP. METHODS: A literature search was performed in January 2020 of MEDLINE, Embase and CINAHL using the Healthcare Databases Advanced Search platform. Included studies reported CIN and/or uterine/cervical malignancy in histological assessment of hysterectomy specimens performed purely for POP. Meta-analysis of prevalence was performed using the MetaXL ( www.epigear.com ) add-in for Microsoft Excel. RESULTS: Six hundred seventy-seven records were identified, out of which 34 studies were eligible. Overall prevalence (95% confidence interval [CI]) of endometrial cancer in 33 studies was 0.004 (0.003-0.006), I2 = 41%, number needed to treat (NNT) 1:250. Total actionable uterine pathology was 0.005 (0.003-0.006) in 33 studies, I2 = 35%, NNT = 1:200. Overall prevalence of cervical cancer in 19 papers was 0.001 (0.000-0.002), I2 = 18%, NNT = 1:1000. In 16 studies the overall prevalence of CIN was 0.013 (0.001-0.033), I2 = 95%, NNT = 1:77. Prevalence of total actionable pathology was 0.013 (0.006-0.0023), I2 = 86%, NNT = 1:77. CONCLUSION: The risk of actionable pathology is low, but not negligible. The variation between populations is wide. The prevalence of finding such pathology supports the routine practice of sending all hysterectomy specimens performed for POP for histological assessment.

Management of Early Cervical Stromal Invasion FIGO Stage 1A1 When Margins Are Involved With Cervical Intraepithelial Neoplasia.

OBJECTIVE: Women with International Federation of Gynecology and Obstetrics stage 1A1 cervical carcinoma were evaluated to determine whether repeat excision for large loop excision transformation zone margins positive with cervical intraepithelial neoplasia (CIN) had been undertaken according to the National Health Service Cervical Screening Programme guidelines and if deviations from guidelines adversely affected patient outcome. MATERIALS AND METHODS: We retrospectively studied patients with 1A1 cervical carcinoma treated in our service between May 2010 and July 2015 to determine whether NHSCSP guidelines (May 2010) were followed. This states that if the invasive disease is excised but CIN extends to the excision margin, then a repeat large loop excision transformation zone should be undertaken to exclude further invasive disease and to confirm excision of CIN. RESULTS: Seventeen patients were identified. In one, neither the invasive lesion nor CIN was fully excised. In 5, the lesion and CIN were fully excised. In eleven, the invasive lesion was excised, but CIN was present at a margin. Of these 11 patients, none opted for a repeat excision. All 11 patients had negative cytology at first follow-up (negative up to 4 years [median = 2 years]). CONCLUSIONS: Our outcomes suggest that it may not be necessary to perform a repeat excision for CIN present at the excision margin in women with 1A1 cervical carcinoma when CIN is present either at the endocervical, deep stromal, or ectocervical margin, as long as the invasive focus is fully excised, and patients have been fully counseled and have regular cytology follow-up. This may be an alternative for patients wanting to minimize the risks to fertility posed by repeat excision.