INDICATIONS AND RESULTS OF FRACTIONAL CUR ETTAGE IN A LARGE GYNECOLOGICAL POPULATION

Aim: To determine whether the term ''fractional D&C'' is justified wit h respect to the uterine cervix and corpus fractions, and what indicat ions and results are found when a large population at a university hos pital is analyzed. Methods: In this retrospective study covering a 3-y ear period at the Department of Gynecology, University Hospital of Zur ich, indications and results of fractional D&C were obtained from hosp ital records stored in a data bank. The curettage results of hysterect omized women were compared with the histological findings of the hyste rectomy specimens. Results: 938 women (mean age 52 years) underwent fr actional D&C, 38% had postmenopausal, 36% premenopausal and 13% perime nopausal abnormal bleeding. For 5% there was a sonographic finding wit hout 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 not hing abnormal was detected, in 14% no conclusive evaluation of the mat erial was possible, and in 3% the histological report showed a maligna ncy. In 20% of the cases the cervix curettage material was contaminate d with material from the uterus cavum. Conclusions: For cases with can cer 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 dat a and recent Iiteratur have prompted us to draw up new criteria for ev aluation of abnormal vaginal bleeding, or a new set of indications for fractional D&C and hysteroscopy.