[Analysis of indications and results of fractional curettage in a large gynecological cohort]

AIM: To determine whether the term "fractional D&C" is justified with respect to the uterine cervix and corpus fractions, and what indications and results are found when a large population at a university hospital is analyzed. METHODS: In this retrospective study covering a 3-year period at the Department of Gynecology, University Hospital of Zurich, indications and results of fractional D&C were obtained from hospital records stored in a data bank. The curettage results of hysterectomized women were compared with the histological findings of the hysterectomy specimens. RESULTS: 938 women (mean age 52 years) underwent fractional D&C. 38% had postmenopausal, 36% premenopausal and 13% perimenopausal abnormal bleeding. For 5% there was a sonographic finding without bleeding disorders, 4% had cervical polyps, 1% breast cancer, and 3% other diagnoses. In 13% of the cases the corpus curettage material could not be evaluated. For 43%, the corpus material appeared normal and in 5% a malignancy was found. In 74% of the cervical fractions nothing abnormal was detected, in 14% no conclusive evaluation of the material was possible, and in 3% the histological report showed a malignancy. In 20% of the cases the cervix curettage material was contaminated with material from the uterus cavum. CONCLUSIONS: For cases with cancer of the cervix, the sensitivity of fractional D&C was 80%, compared with a specificity of 66.7%. With a positive predictive value of 52.2%, the term "fractional D&C" is in many cases not justified. Our data and recent literature have prompted us to draw up new criteria for evaluation of abnormal vaginal bleeding, or a new set of indications for fractional D&C and hysteroscopy.