DefinePK

Research Objective

To analyze the clinical indications for abdominal hysterectomy and correlate them with histopathological findings.

Methodology

Cross-sectional study conducted at the Department of Gynecology and Obstetrics, PNS Shifa, Karachi, Pakistan, from July 2017 to June 2019. Data on patient demographics, presenting complaints, clinical features, indications, type of hysterectomy, and histopathology reports were collected and analyzed. A comparison was made between clinical indications and histopathological findings. Statistical analysis was performed using SPSS version 23.0, with quantitative variables expressed as mean±SD and qualitative variables as frequency and percentages. The Pearson Chi-square test was used to analyze differences between pre-operative and histopathological diagnoses, with a p-value of 0.05 considered significant.

Methodology Flowchart

                        graph TD
    A["Data Collection: Patient Demographics, Clinical Data, Histopathology Reports"] --> B["Comparison of Clinical Indications and Histopathological Findings"];
    B --> C["Statistical Analysis"SPSS, Chi-square test""];
    C --> D["Identify Key Findings and Discrepancies"];
    D --> E["Formulate Conclusions and Implications"];                    

Discussion

The study highlights that fibroid uterus is the most common pathology requiring hysterectomy. While there was a high correlation between clinical and histopathological diagnoses for leiomyoma, cervical polyps, and endometrial polyps, a significant discrepancy was observed for abnormal uterine bleeding without organic pathology, where many cases were found to have chronic cervicitis on histopathology. The authors emphasize the importance of histopathological examination for accurate diagnosis and optimal patient management, especially in cases of suspected malignancy.

Key Findings

A total of 180 hysterectomies were performed. Heavy menstrual bleeding due to fibroid uterus was the most common indication (42.22%), followed by menstrual irregularities without organic pathology (21.80%). The most common histopathological diagnosis was leiomyoma/fibroid (43.33%), followed by chronic cervicitis (32.77%). Preoperative diagnosis of fibroid uterus was confirmed by histopathology in 78 cases (43.33%). Abnormal uterine bleeding without organic pathology was preoperatively diagnosed in 39 cases (21.80%), but histopathology confirmed it in only 22 cases (12.22%). Chronic cervicitis was an incidental finding in 59 cases (32.77%) on histopathology. Overall, 79.44% of clinical diagnoses were confirmed by histopathology.

Conclusion

Fibroid uterus is the most common pathology identified in hysterectomy specimens. A high confirmation rate exists between clinical and histopathological diagnoses for leiomyomas, adenomyosis, endometrial polyps, and hyperplasia. However, a notable discrepancy exists for abnormal uterine bleeding without organic pathology, often revealing chronic cervicitis. Histopathological examination of surgical specimens is crucial for confirming diagnoses and guiding further management, including the detection of malignancies.

Fact Check

1. Number of Hysterectomies: 180 hysterectomies were performed during the study period. (Confirmed in Results section)
2. Most Common Histopathological Diagnosis: Leiomyoma/fibroid was the most common histopathological diagnosis, found in 78 cases (43.33%). (Confirmed in Results section)
3. Correlation for Leiomyoma: The clinical and histopathological correlation was 100% in cases of leiomyoma. (Confirmed in Conclusion section)

Mind Map