Dilatation and curettage fails to detect most focal lesions in the uterine cavity in women with postmenopausal bleeding

TLDR

The study aims to determine the prevalence of focal uterine lesions in postmenopausal bleeding patients with endometrium ≥ 5 mm and how accurately dilation and curettage (D&C) detects them. In a prospective cohort of 105 such women, diagnostic hysteroscopy, D&C, and hysteroscopic resection of any remaining focal lesions were performed, with 24 also undergoing hysterectomy. Eighty percent of participants had uterine pathology, 98 % of which were focal; D&C missed 58 % of polyps, 50 % of hyperplasias, 60 % of complex atypical hyperplasias, and 11 % of cancers, whereas hysteroscopy with resection identified all residual lesions, proving superior to D&C.

Abstract

Objective. To determine the prevalence of focally growing lesions in the uterine cavity in women with postmenopausal bleeding and endometrium ≥5 mm and the extent to which such lesions can be correctly diagnosed by D&C. Methods. In a prospective study, 105 women with postmenopausal bleeding and endometrium ≥5 mm at transvaginal ultrasound examination underwent diagnostic hysteroscopy, D&C and hysteroscopic resection of any focally growing lesion still left in the uterine cavity after D&C. Twenty‐four women also underwent hysterectomy. If the histological diagnosis differed between specimens from the same patient, the most relevant diagnosis was considered the final one. Results. Eighty percent (84/105) of the women had pathology in the uterine cavity, and 98% (82/84) of the pathological lesions manifested a focal growth pattern at hysteroscopy. In 87% of the women with focal lesions in the uterine cavity, the whole or parts of the lesion remained in situ after D&C. D&C missed 58% (25/43) of polyps, 50% (5/10) of hyperplasias, 60% (3/5) of complex atypical hyperplasias, and 11% (2/19) of endometrial cancers. The agreement between the D&C diagnosis and the final diagnosis was excellent (94%) in women without focally growing lesions at hysteroscopy. Conclusion. If there are focal lesions in the uterine cavity, hysteroscopy with endometrial resection is superior to D&C for obtaining a representative endometrial sample in women with postmenopausal bleeding and endometrium ≥5 mm.