D&C. You’ve likely heard the term before, but now that your doctor has ordered the procedure for you, it’s time to learn a little more about it. Although the procedure has been performed for a long time, there are some advancements you should be aware of.

What a D&C is and why it’s used
D&C stands for dilation and curettage. It’s a procedure where your doctor opens (dilates) your cervix, which is the opening to your uterus. Your doctor then inserts a thin instrument (curette) that helps remove tissue from inside your uterus.¹

A D&C is used to diagnose and treat conditions that affect the uterus, such as abnormal bleeding caused by unwanted tissue like fibroids, polyps, or cancer. It may also be performed to clear tissue that remains after a pregnancy. Depending on the reason for the procedure, the removed tissue may then be viewed under a microscope to check for abnormal cells.

Often, an endometrial biopsy is done before the D&C in your doctor’s office. Your doctor collects a small sample from the lining of your uterus (the endometrium) and sends it to a lab for testing. If the results show that more information is needed, your doctor may then move ahead with the D&C. While an endometrial biopsy removes just a sample of tissue, a D&C removes much more of the top layer of the uterine lining.

Visual D&C versus blind D&C
Some D&Cs are done with a procedure called a hysteroscopy, where your doctor uses a thin, lighted telescope (hysteroscope) that is inserted through your cervix into your uterus. The hysteroscope transmits the image of your uterus onto a screen, which lets your doctor see the tissue that’s being removed. This is called a visual D&C. If your doctor doesn’t use the visualization offered by a hysteroscope, your procedure may be referred to as a blind D&C.

Blind D&Cs are performed using a surgical tool, which can be a sharp curette or a suction device. Visual D&Cs are often performed using special tissue removal devices.

How they compare
Studies show that blind D&C is associated with a high rate of complications like unintended injury to your uterus,² low diagnostic accuracy or not correctly identifying your problem,² and a failure to detect problematic tissue at all, including 58 percent of polyps and 11 percent of endometrial cancers.³

The fact is that many women with gynecological issues don’t have focal pathologies⁴—this means that their problematic issue isn’t located in just one area. So, if doctors use blind D&C to scrape away tissue but can’t see what they’re scraping, they could fail to remove some or even any of the unwanted tissue.

Adding further weight to visual D&C as a better option—it’s the recommendation of the leading OBGYN society, The American College of Obstetricians and Gynecologists (ACOG): “If a (physician decides a) surgical approach is favored, D&C with hysteroscopic guidance is recommended over (blind) D&C alone because it has higher accuracy and superior diagnostic yield.”⁵ Meaning, if you have to have surgery to diagnose or treat your symptoms, the surgeon should use a camera while doing it.

The use of specialized uterine tissue removal devices with a visual D&C makes this an even stronger option. Physicians were surveyed about their experience with tissue collection methods and tools. Tissue removal devices had the lowest reported failure rate for tissue collection during a D&C procedure.⁶ Those physicians who use tissue removal devices for sampling chose them because they are likely to get an adequate sample⁶–and adequate samples are necessary for diagnosing endometrial conditions.

Other reasons why physicians chose tissue removal devices included ease of use, patient safety, cost, patient comfort and satisfaction, and the fact that they are recommended by ACOG.⁶

Why it matters
If your unwanted tissue isn’t completely removed (sometimes called incomplete sampling), you may be left with symptoms that don’t go away, feelings of uncertainty and anxiety, the inconvenience and stress of multiple follow-up visits (not to mention the cost), and—perhaps most important—you may be at long-term risk of serious abnormalities.

Let’s look at endometrial cancer as an example. It is the most common cancer of the female reproductive tract,⁷ and the first sign patients usually have is abnormal uterine bleeding.⁸ If endometrial cancer is diagnosed and treated early, survival rate is very high—in fact, when diagnosed at stage I, 90% of women will have no sign of cancer 5 or more years after treatment.⁸ But if the cancer is missed during the initial sampling, the opportunity for early diagnosis and treatment is diminished.

You can see why choosing the most precise and accurate D&C option really does matter.

More information coming in our next blog
We’ve covered a lot here, but there’s still much more to talk about. For now, you can visit https://gynsurgicalsolutions.com/patients/for-patients/ for more information on heavy periods, fibroids, and other uterine health issues. Then come back next month for part two of this topic, where we’ll discuss how to make sure you receive the D&C method that is best for you.

References:

1. The American College of Obstetricians and Gynecologists. FAQs: Dilation and curettage. https://www.acog.org/womens-health/faqs/dilation-and-curettage. Accessed August 31, 2022.
2. Salim S, Won H, Nesbitt-Hawes E, Campbell N, Abbott J. Diagnosis and management of endometrial polyps: a critical review of the literature. J Minim Invasive Gynecol. 2011;18(5):569-581. doi: 10.1016/j.jmig.2011.05.018
3. Epstein E, Ramirez A, Skoog L, Valentin L. Dilatation and curettage fails to detect most focal lesions in the uterine cavity in women with postmenopausal bleeding. Acta Obstet Gynecol Scand. 2001;80(12):1131-1136. doi: 10.1034/j.1600-0412.2001.801210.x
4. Svirsky R, Smorgick N, Rozowski U, Sagiv R, Feingold M, Halperin R, Pansky M. Can we rely on blind endometrial biopsy for detection of focal intrauterine pathology? Am J Obstet Gynecol. 2008;199(2):115.
5. The American College of Obstetricians and Gynecologists (ACOG). Practice bulletin no. 149: endometrial cancer. Obstet Gynecol. 2015;125(4):1006-1026.
6. Hologic, Inc. Data on file. Tissue Collection Methods Survey. Conducted June 2021 by Gerson Lehman Group for Hologic, Inc, N=121.
7. American Cancer Society. Key statistics for endometrial cancer. https://www.cancer.org/cancer/endometrial-cancer/about/key-statistics.html. Accessed August 31, 2022.
8. The American College of Obstetricians and Gynecologists. FAQs: Endometrial cancer. https://www.acog.org/womens-health/faqs/endometrial-cancer. Accessed August 31, 2022.