Occult Uterine Malignancy at the Time of Surgery for Uterine Fibroids: A Systematic Review

Study Objective Previous systematic reviews have focused specifically on the prevalence of leiomyosarcoma at the time of surgery for uterine fibroids. Recognizing that the other subtypes of uterine cancer are more prevalent, we wanted to conduct a systematic review to estimate the prevalence of occult uterine malignancy, of any subtype, among women undergoing surgery for uterine fibroids. Design Systematic Review. Setting N/A Patients or Participants Women undergoing surgery for uterine fibroids. Interventions Hysterectomy and Myomectomy. Measurements and Main Results The PRISMA guidelines were followed in this systematic review. The search terms used were “occult malignancy” or “occult uterine pathology” paired with “morcellation” or “hysterectomy.” March 25, 2019 was the last date that articles were searched. We did not restrict articles based on language or publication date. Inclusion criteria included any peer-reviewed journal articles reporting occult uterine malignancy rates at the time of surgery for benign conditions, regardless of whether morcellation was used or not. We excluded articles that were reported exclusively on women with pre-operatively diagnosed or suspected uterine malignancies. Our search yielded a total of 233 journal articles, of which 53 met the criteria for a full-text review and 27 were included in the final systematic review. Of these 27 studies, 8 specifically provided data on occult uterine malignancy among women undergoing surgery for uterine fibroids. These 8 studies incorporated 105,890 patients, across 5 countries, with presumed fibroids. A total of 578 occult uterine malignancies were found. The overall crude prevalence of occult uterine malignancy was 0.55% (95% CI 0.50 – 0.59%). Conclusion This is the first systematic review to estimate the prevalence of occult uterine malignancies (all subtypes combined) at the time of surgery specifically for uterine fibroids. Based on our systematic review, the crude prevalence of occult uterine malignancy across this population is 0.55%.