Clinicopathological Correlation of Non Oncological Hysterectomies at a Tertiary Healthcare Centre

Abstract

Introduction: Hysterectomy is a common surgical procedure for benign gynaecologic pathologies despite the availability of conservative treatment options. However, studies indicate many health and psychosexual complications following this procedure. Regular histopathological audit of hysterectomies in relation to the clinical rationale will provide valuable data and insight and thus, lead to improved knowledge and expertise. AIM: To correlate clinical and histopathological diagnosis in hysterectomies for non oncological indications and assess the agreement between the two modalities. Materials and Methods: A retrospective cross-sectional study with comparative clinicopathological analysis which included 702 hysterectomies for non oncological indications during a one-year period (April 2019 to March 2020) was carried out in the Department of Pathology at a tertiary healthcare centre in Ajmer, Rajasthan, India. Cohen-kappa value was determined to measure the degree of agreement between clinical and histopathological diagnosis. A comparative clinicopathological analysis was done by segregating cases into two categories-those with structural pathologies and the other with non structural/functional pathologies. Results: A total of 702 hysterectomy specimens were studied. The clinicopathological concordance for structural lesions was better than functional aetiologies (87.52% vs 57.8%). Leiomyoma (AUB-L) was the most frequent clinical and histopathological diagnosis. Histopathology revealed more structural lesions than clinically suspected (81.2% vs 75.36%). The Cohen-kappa value revealed an overall fair agreement between clinical and histopathological judgement (K=0.27). Clinicopathological- agreement was lower in adenomyosis, dual structural pathologies while it was better for polyps, leiomyomas, obstetric pathologies and procidentia. Conclusion: Although, an overall fair degree of agreement was found between clinical and histopathological diagnosis, conditions that lack a specific clinical presentation or a sensitive diagnostic test like adenomyosis showed poor clinicopathological agreement. Histopathology is a vital tool to verify the appropriateness of the clinical indication of hysterectomies. Frequent clinicopathological correlation helps in improving knowledge and expertise of the healthcare provider, thus improving future clinical judgements.