Correlation of Clinical and Ultrasound Finding with Histopathological Diagnosis in Cases of Hysterectomy – A Cross Sectional Study

Background: Hysterectomy is one of the most common gynaecological operations performed throughout the world and is an effective treatment for a various gynaecological disease. Histopathological analysis is mandatory to reach definitive diagnosis and it carries ethical, legal, diagnostic and therapeutic issue. Hence every specimen must be subjected to HPE. There must be periodic audit for appropriate hysterectomy indications and efficiency of diagnostic tools must be assessed for making diagnosis and for considering conservative management before surgery. This study aim to review the demographic profile, various patterns of pathological lesions (both definitive and incidental), to assess the correlation between the clinical diagnosis, radiological findings and histopathological report in hysterectomy specimens. Methods: This prospective study was conducted on 300 hysterectomy patients who met inclusion criteria during one year of study period; June 2012 to October 2013 in the department of obstetrics and gynaecology at NSCB medical college and Hospital. Detail history, Clinical examination, Radiological findings and provisional diagnosis of the patients was recorded. Histopathological diagnosis was correlated with preoperative diagnosis. Results: During the study period, Out of 374 cases,300 hysterectomy done for benign reason; So making incidence of 80%. Of this 58% of cases were of age group 41-50 years, the most common age group i.e. perimenopause age group. Multiparous women has increased incidence being 97% as compared to 1% for Nulliparous. More than half of specimen 61% show leiomyoma and adenomyosis on Histopathological analysis. Most common preoperative diagnosis was leiomyoma (41.3%) followed by uterine prolapse (28%). Correlation between Clinical diagnosis and Histopathology was 90% for fibroid, 73% of prolapse,100% for adenomyosis, 95% for ovarian mass. Conclusion: In our study, overall correlation between preoperative diagnosis and postoperative histological diagnosis were strong and significant. However there is room for diagnostic improvement. Some lesions that were diagnosed by histology could have been diagnosed preoperatively, with consideration of conservative management. Many benign lesions do not require a total hysterectomy for definitive treatment. Hence hysterectomy should not be considered the only options of treatment especially in young pre-menopausal women if adequate conservative treatments are available.