New light on prevalence of uterine cancer in morcellation cases

The first paragraph this item has been edited to correct an error in prevalence that appeared in the original version of the e-newsletter.

An analysis of minimally invasive hysterectomies performed at multiple institutions over a 7-year period shows that one in every 368 women who underwent morcellation had uterine cancer. According to the investigators, the study also reveals an association between advanced age and increasing prevalence of underlying cancer and endometrial hyperplasia in these patients.

Published in JAMA, the findings reflect outcomes in a cohort of 232,882 women who underwent minimally invasive hysterectomy from 2006 to 2012 whose cases were included in the Perspective database. Perspective includes more than 500 hospitals and captures 15% of hospitalizations. For the two-sided statistical analysis, authors from Columbia University created multivariable mixed-effects log-linear models for uterine cancer and endometrial hyperplasia.

Among the 36,470 (15.7%) women who had morcellation, 99 cases of uterine cancer were identified, as well as 26 other gynecologic malignancies (7/10,000), 39 uterine neoplasms of uncertain malignant potential (11/10,000), and 368 cases of endometrial hyperplasia (101/1,000). The study showed a prevalence of uterine malignancy in women undergoing morcellation that increased from 4.97 at ages 50 to 54 to 19.37 at ages 55 to 59, 21.36 in women aged 60 to 64, and 35.97 in those aged 65 and older.

The authors noted that although morcellators have been in use for more than 20 years, theirs is one of few studies to look at prevalence of unexpected pathology at hysterectomy. They acknowledged that the analysis’s limitations include inability to verify pathological findings, possible misclassification of pathology, potential undercapture of morcellation, and the possibility that the findings-from largely urban teaching centers located in the southern United States-may not be generalizable to all hospitals.

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