[1247] Histopathologic Features of 164 Failed Endometrial Ablation Cases

Rochelle A Simon, M Ruhul Quddus, Cunxian Zhang, Margaret M Steinhoff, W Dwayne Lawrence, C James Sung. Brown University/Women & Infants Hospital, Providence, RI

Background: Dysfunctional uterine bleeding (DUB) is common and not always successfully managed medically. Hysterectomy is an option when medical therapy fails; however, endometrial ablation is a minimally invasive alternative. Although the failure rate is low, continued DUB after ablation does occur. We analyzed the histopathologic features of hysterectomy specimens after ablation.
Design: We retrieved cases of hysterectomy after ablation between 2001 and 2010. Control cases were defined as post-ablation hysterectomies for indications other than DUB. In each case, the ablation-hysterectomy interval and detailed histologic features comprising changes of ablation were recorded. The presence of these features was compared between study and control groups, and with the ablation-hysterectomy interval. Statistical analysis was performed via Student's t-test and Fisher Exact Test.
Results: We identified 164 cases (including 35 control cases) in patients 23-62 yrs of age (median=42 yrs). In 53 cases, the entire endometrial surface was examined histologically. Table 1 lists the histopathologic features noted. Significant differences in the ablation-hysterectomy interval were noted between: those with coagulative necrotic debris (median: 5 mos., range: 0.75-72 mos.) and those without (median: 23 mos., range: 1-132 mos.); those with superficial, congested, viable blood vessels (median: 2 mos., range: 0.75-53 mos.) and those without (median: 18 mos., range: 1-132 mos.); and those with dense fibrosis (median: 26 mos., range: 4-84 mos.) and those without (median: 9.5 mos., range: 0.75-132 mos.). Patients with prior tubal ligation were more likely to have continued DUB (p=0.0021).

FindingStudy (n=129)Control (n=35)
% surface ablated  
<26%62 (48.1%)9 (25.7%)
>75%46 (35.7%)23 (65.7%)
Fibrosis23 (17.8%)13 (37.1%)
Coagulative necrotic debris45 (34.9%)14 (40.0%)
Superficial congested vessels15 (11.6%)5 (14.3%)
Ablated LUS only12 (9.3%)2 (5.7%)
Cornual region spared2 (1.6%)1 (2.9%)
Adenomyosis67 (51.9%)12 (40.0%)
Leiomyoma63 (48.8%)16 (45.7%)
Prior tubal ligation63 (48.8%)7 (20.0%)
History of endometriosis12 (9.3%)5 (14.3%)



Conclusions: Possible sources of continued DUB include: coagulative necrotic debris, which may persist for years; superficial, congested blood vessels—persistent and viable even after the remainder of the endometrium is ablated; re-epithelialization of the endometrium via adenomyosis; endometriosis associated with proximal dilatation of the fallopian tube after ligation; and residual endometrium present due to spared cornual regions, ablated LUS only, or irregular ablation due to submucosal leiomyoma.
Category: Gynecologic & Obstetrics

Wednesday, March 21, 2012 1:00 PM

Poster Session VI # 194, Wednesday Afternoon

 

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