Histologic findings in hysterectomies after endometrial ablation.
Ablation
Fibrosis
Modifications
Necrosis
Novasure
Post-treatment
Radiofrequency
Thermachoice
Thermal injury
Journal
Pathology, research and practice
ISSN: 1618-0631
Titre abrégé: Pathol Res Pract
Pays: Germany
ID NLM: 7806109
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
received:
15
03
2020
accepted:
22
04
2020
pubmed:
2
6
2020
medline:
15
5
2021
entrez:
2
6
2020
Statut:
ppublish
Résumé
Endometrial ablation for abnormal uterine bleeding is used as a less invasive alternative to hysterectomy, however, in cases of treatment failure hysterectomy may be finally performed. The histologic changes in these post-treatment uteri are not well-described. To describe the histological findings in post-endometrial ablation uteri. During a ten-year period, 321 patients were treated with endometrial ablation. Twenty-five patients (7.8%), 10 treated with NovaSure® and 15 treated with ThermaChoice® endometrial ablation were finally subjected to hysterectomy mostly due to persistent uterine bleeding. Histologic features of these hysterectomies are described. The patients' age ranged from 33 to 73 years (mean 44.5) and 34-53 (mean 42) for the NovaSure® and ThermaChoice® group, respectively. The time from endometrial ablation to hysterectomy was 2-24 months (mean 8.8) and 2-60 months (mean 23.2) for the two groups, respectively (p = 0.01). Hysterectomies performed later (mean 22 months) showed no fibrosis (p = 0.04) compared with those performed earlier (mean 5 months). Endometrial lining was found more frequently in hysterectomies performed later (mean 13 months) than those performed earlier (mean 2 months, p = 0.0004). Abundant necrotic tissue of myometrial origin was found in 28% of the cases, but it was not associated with the time of hysterectomy (p = 0.2). A zonation effect and vascular changes also seen. Granulomatous reaction was not found. Ten patients (40%) harbored adenomyosis and another three (12%) extensive leiomyomas/diffuse leiomyomatosis. Necrosis, fibrosis and vascular changes are found during the first year of post-thermal uterine effect. Hysterectomies performed later show less prominent changes and almost normal endometrial lining. Adenomyosis is found in an important part of post-endometrial ablation hysterectomies.
Sections du résumé
BACKGROUND
BACKGROUND
Endometrial ablation for abnormal uterine bleeding is used as a less invasive alternative to hysterectomy, however, in cases of treatment failure hysterectomy may be finally performed. The histologic changes in these post-treatment uteri are not well-described.
OBJECTIVE
OBJECTIVE
To describe the histological findings in post-endometrial ablation uteri.
STUDY DESIGN
METHODS
During a ten-year period, 321 patients were treated with endometrial ablation. Twenty-five patients (7.8%), 10 treated with NovaSure® and 15 treated with ThermaChoice® endometrial ablation were finally subjected to hysterectomy mostly due to persistent uterine bleeding. Histologic features of these hysterectomies are described.
RESULTS
RESULTS
The patients' age ranged from 33 to 73 years (mean 44.5) and 34-53 (mean 42) for the NovaSure® and ThermaChoice® group, respectively. The time from endometrial ablation to hysterectomy was 2-24 months (mean 8.8) and 2-60 months (mean 23.2) for the two groups, respectively (p = 0.01). Hysterectomies performed later (mean 22 months) showed no fibrosis (p = 0.04) compared with those performed earlier (mean 5 months). Endometrial lining was found more frequently in hysterectomies performed later (mean 13 months) than those performed earlier (mean 2 months, p = 0.0004). Abundant necrotic tissue of myometrial origin was found in 28% of the cases, but it was not associated with the time of hysterectomy (p = 0.2). A zonation effect and vascular changes also seen. Granulomatous reaction was not found. Ten patients (40%) harbored adenomyosis and another three (12%) extensive leiomyomas/diffuse leiomyomatosis.
CONCLUSION
CONCLUSIONS
Necrosis, fibrosis and vascular changes are found during the first year of post-thermal uterine effect. Hysterectomies performed later show less prominent changes and almost normal endometrial lining. Adenomyosis is found in an important part of post-endometrial ablation hysterectomies.
Identifiants
pubmed: 32475645
pii: S0344-0338(20)30773-1
doi: 10.1016/j.prp.2020.152992
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
152992Informations de copyright
Copyright © 2020 Elsevier GmbH. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest The authors have no conflict of interest to disclose