Preoperative Diagnostic Evaluation in Patients Undergoing Hysterectomy and the Incidence of Incidental Diagnosis of Gynecologic Malignancy: A Single-Institution Experience in a Tertiary Care Setting [ID 1663]

INTRODUCTION: The incidence of endometrial cancer diagnosis after a benign hysterectomy is reported to be very rare. Delayed cancer diagnosis may result in additional surgery, delayed adjuvant therapy, and poorer patient outcomes. The objective of this study is to assess the incidence of incidental diagnosis of endometrial cancer and trends in preoperative evaluation of hysterectomies in a high-volume tertiary care setting. METHODS: Patients aged 18–100 who underwent a hysterectomy for benign indication between January 1, 2022, and December 31, 2022, were included. Exclusion criteria were hysterectomies that were unplanned, emergent, or performed by gynecologic oncologists. Descriptive statistics were used for preidentified demographics and risk factors. RESULTS: A total of 1,057 hysterectomies were performed. The most common indications for surgery included abnormal uterine bleeding (N=534, 50.5%), pelvic pain (N=340, 32.2%), pelvic organ prolapse (N=335, 31.7%), and leiomyomata (N=261, 24.7%). A preoperative endometrial biopsy was performed in 351 (33.2%) patients. Preoperative imaging was performed in 637 (60.3%) patients, including pelvic ultrasound (N=607, 57.4%), CT (N=71, 6.7%), and MRI (N=34, 3.2%). In total, 12 (1.1%) oncologic diagnoses were identified on final pathology (3 endometrial, 1 gestational trophoblastic neoplasm, 1 ovarian borderline, 2 serous tubal intraepithelial neoplasias [STIC], 2 ovarian, 1 uterine leiomyosarcoma, 1 cervical, 1 metastatic breast). Of the three endometrial cancers, none required additional surgery or adjuvant therapy. CONCLUSIONS/IMPLICATIONS: Although the rate of incidentally diagnosed endometrial cancer is low at 0.3%, comprehensive and clinically appropriate work-up remains a critical aspect of benign surgical practice.