Review of Hysterectomies done for Cervical Intraepithelial Neoplasias (CIN) in a teaching referral Hospital

Abstract

Background: Cervical cancer is the second most frequent cancer among women in Ethiopia. The country has no formal cervical cancer screening program. There is limited cytological service and no clear guideline as to how to manage cases of CIN. Outpatient local ablative therapies are usually not available and hysterectomies are sometimes used as one option of definitive management. Objectives: To review hysterectomies done primarily for management of CIN diagnosed using pap-smear and or cervical Punch biopsy. Methodology: Eight years retrospective document (November 2004 - January 2013) on all hysterectomies performed for CIN at St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia was reviewed. The review employed a structured questionnaire to collect important variables from the medical records. Results: A total of 2,163 hysterectomies were performed in the 8 years period of which73 (3.37%) were performed for CIN. Sixty medical records were available for review (82% retrieval rate). The degree of abnormality of the pap smear were 16(26.7%) CIN I, 17(28.3 %) CIN II and 13(21.7%) CIN III. Three cases(5%) each have a pap report of LSIL and HSIL respectively. The rest eight have CIN diagnosed by punch biopsy. Pre-operative biopsy of the cervix was done in 36 (60%) of patients. Histological studies from the hysterectomy specimen was done for 50 (83.3%) of the patients and showed 9 (18%) normal, 12 (24%) CIN I, 11 (22%) CIN II, 7 (14%) CIN III, 6 (12%) invasive cancer and 5(10%) others. Fifty five (91.7%) of hysterectomies were done abdominally and 5(8.3%) vaginally. The mean hospital stay was 9.07 days. Post-operative complications include anemia 9(15%), UTI 7(11.7%) and superficial wound infection in 6 (10%). Conclusion: Hysterectomy is being used in the management of CIN lesions including those assessed as low grade lesions. Large number of patients did not have a pre-operative cervical biopsy before hysterectomy, even in those Pap smear showed high grade lesions. It is high time to introduce outpatient treatment modalities of CIN rather than using hysterectomy as a primary treatment modality due to the fact that morbidity and unnecessary burden on the health care system (Ethiopian Journal of Reproductive Health, 2014, Volume 7(1),42-48).