Risk of abnormal histology following vaginal hysterectomy for pelvic organ prolapse in a multi-ethnic Asian population: a two-year retrospective review.
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OBJECTIVE: Vaginal hysterectomy is frequently performed for benign conditions like pelvic organ prolapse. While pre-operative screening is intended to pick up malignancies in advance, unexpected findings of abnormal histology can still arise post-operatively. This study aims to determine the prevalence of unanticipated gynaecological malignancy and pre-malignancy in women who underwent vaginal hysterectomy for pelvic organ prolapse in a multi-ethnic Asian population. METHODS: A retrospective audit of medical records of 512 women underwent vaginal hysterectomy with or without salpingo-oophorectomy for the treatment of pelvic organ prolapse between 1 January 2023 and 31 December 2024 at KK Women's and Children's Hospital, Singapore, was conducted. Patients with pre-operative diagnosis of gynaecological malignancy or pre-malignancy were excluded. Pre-operative demographic data, cytopathological and histopathological investigations, as well as post-operative histopathological results were reviewed. RESULTS: Abnormal histopathological findings were identified in 34 patients (6.6 %) post-operatively. Malignancy was diagnosed in 4 patients (0.8 %) while pre-malignant histology was found in 29 patients (5.7 %). Four patients (0.8 %) were diagnosed with endometrial carcinoma and 27 patients (5.3 %) were found to have endometrial hyperplasia. Two (0.4 %) patients had cervical intraepithelial neoplasia despite normal pre-operative cervical screening. Among the 88 patients who underwent concurrent salpingo-oophorectomy, 1 patient (1.1 %) was found to have carcinoid tumour of the ovary. CONCLUSION: Routine histopathological examination of hysterectomy specimens is essential. While the risk of unanticipated gynaecological malignancy is low, women undergoing prolapse surgery should be advised the risk of undetected concurrent malignant and pre-malignant gynaecological conditions.