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).
|Finding||Study (n=129)||Control (n=35)|
|% surface ablated|
|<26%||62 (48.1%)||9 (25.7%)|
|>75%||46 (35.7%)||23 (65.7%)|
|Fibrosis||23 (17.8%)||13 (37.1%)|
|Coagulative necrotic debris||45 (34.9%)||14 (40.0%)|
|Superficial congested vessels||15 (11.6%)||5 (14.3%)|
|Ablated LUS only||12 (9.3%)||2 (5.7%)|
|Cornual region spared||2 (1.6%)||1 (2.9%)|
|Adenomyosis||67 (51.9%)||12 (40.0%)|
|Leiomyoma||63 (48.8%)||16 (45.7%)|
|Prior tubal ligation||63 (48.8%)||7 (20.0%)|
|History of endometriosis||12 (9.3%)||5 (14.3%)|