Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 86643

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2011 | Month : November | Volume : 5 | Issue : 6 | Page : 1199 - 1202 Full Version

Pearls And Pitfalls Of Endometrial Curettage With That Of Hysterectomy In DUB

Published: November 1, 2011 | DOI:
Pammy Sinha, P.R. Rekha, P.G. Konapur, R.Thamil Selvi, P. M. Subramaniam

Corresponding Author Associate Professor, Department of pathology, Vinayaka Mission’s Medical College, Salem. Tamilnadu Professor, Department of pathology, Vinayaka Mission’s Medical College, Salem. Tamilnadu Associate Professor, Department of pathology, Vinayaka Mission’s Medical College, Salem. Tamilnadu.

Correspondence Address :
Pammy Sinha,
Professor of Pathology
Door No. 39, Plot No.43, Palaniappa-Nagar,
Thiruvagoundanur, Salem- 5
Mobile : 9003656209
Email :


Aim and objectives : To study and compare the concordance of various histomorphological patterns in endometrial curettage and the subsequent hysterectomy specimen in dysfunctional uterine bleeding and hence to evaluate the causes for the disconcordance.

Material and Method : All the 131 cases which presented with DUB from January 2005 to December 2009 and which underwent endometrial curettage and subsequent hysterectomy were studied and analyzed for concordance and disconcordance.

Results : Our cases ranged in ages from 28–65 years and presented clinically with DUB, the mean duration between the curettage and the hysterectomy being 4.5 weeks.51.1% of the cases showed concordance between the fractional curettage and hysterectomy and the highest concordance was seen in the phasing of the endometrium, followed by complex hyperplasia and then simple hyperplasia. However, 4.58% of the cases of the fractional curettage were inadequate to report.

Conclusion : The consistency rate of the endometrial tissue from the curettage and the hysterectomy specimens was only modest. This rate was lower in simple hyperplasia as compared to complex hyperplasia.


Endometrial hyperplasia, Fractional curettage, Hysterectomy, Concordance.

The endometrium is a dynamic tissue with physiological and characteristic morphological changes during the menstrual cycle as a result of the sex steroid hormones which are co-ordinately produced in the ovary. “Dating” the endometrium by its histological appearance is often used clinically to assess the hormonal status, to document the ovulation and to determine the causes of endometrial bleeding and infertility (1).

Endometrial sampling began with the introduction of the dilatation of the cervix and the curettage of the uterus (D and C) in the19th century and since then it has been considered as a therapeutic procedure for removing the uterine abnormalities including malignancies and for relieving the symptoms of abnormal uterine bleeding. Now, it has been added up with the advantage of providing endometrial tissue for histopathological examination, which remains as the gold standard diagnostic procedure for detecting uterine abnormalities. The routine application of D and C in abnormal bleeding disorders was reappraised in the light of the development of miniature devices and new uterine imaging modalities, which has resulted in less invasive and cheaper out patient biopsy devices (2).

The endometrium can be sampled blindly or under direct and indirect endoscopic vision. The abdominal removal of the uterus is known as total abdominal hysterectomy and the supracervical removal of the uterus is called as subtotal hysterectomy (3). Charles Clay performed the first subtotal hysterectomy in Manchester, England, in 1843 and the first total hysterectomy in 1929. Since the early 20th century, hysterectomy has been a definite treatment of pelvic pathologies, including fibroid uterus, abnormal heavy bleeding, chronic pelvic pain, endometriosis, adenomyosis, uterine prolapse, pelvic inflammatory disease and cancer of the reproductive organs. It is one of the most common surgical procedures with a rate of 6.1-8.6/1000 in all the age groups . The ultimate diagnosis can bemade only by histopathology and so every hysterectomy specimen should be subjected to a histopathological examination (4).

The endometrial mucosa is made up of glands and stroma which are divided into a deep seated basal layer and a superficial functional layer. The basal layer is equivalent to the reserve cell layer of the other epithelia and it is responsible for the generation of the endometrium following menstruation. The functional layer is further subdivided into the strata compactum and the strata spongiosum, whereas the stroma is composed of endometrial stromal cells, vessels and stromal granulocytes.The normal endometrium undergoes a series of sequential changes in the ovulatory cycle and it is associated with changes in both the endometrial glands and the stroma (5).

The cycle begins with the menstrual phase where the shedding of the upper half to two thirds of the endometrium takes place, which is followed by the proliferative phase under the influence of oestrogen which is produced by the granulosa cells of the developing follicles in the ovary.The endometrium undergoes an extremely rapid growth of both the glands and the stroma.The glands are straight and they are lined by regular, tall, pseudo-stratified columnar cells with mitotic figures and the stroma is compact. The post-ovulatory endometrium is marked by secretory vacuoles beneath the nuclei in the glandular epithelium and the glands are tortuous, producing a serrated appearance (1).

Hyperplasia is the increase in the size of an organ or tissue due to an increase in the number of its specialized cells. The endometrium is capable of marked hyperplasia as a response to the stimulus of prolonged and unopposed oestrogen (6). The current classification which was introduced by Kurman et al 1985, has been accepted by the WHO and the ISGP. This classification considers two criteria (glandular complexity and nuclear atypicality) and there are four diagnostic categories of endometrial hyperplasia: simple hyperplasia (SH), complex hyperplasia (CH), simple atypical hyperplasia (SAH)and complex atypical hyperplasia (CAH) (7),(8),(9).

Endometrial hyperplasia (EMH) is a pathological condition of the endometrium which carries both clinical and pathological significance. It is one of the most important pre-disposing factors for the development of endometrial carcinoma (EMC).

The risk is especially seen with atypical EMH which carries the risk of associated endometrial carcinoma more than EMH without atypia (10).

Studies have shown that only 10–20% of the endometrial hyperplasias progress to carcinomas when they are left untreated. (11) We studied and correlated the consistency between the histopathology of the endometrial curettages and the subsequent hysterectomy specimens.

Traditionally, dilatation and curettage (D and C) has been the method of choice for obtaining an endometrial sample. However, in two studies which comprised of both pre- and post-menopausal women with abnormal uterine bleeding, 40–90% of the polyps and 43–66% of the hyperplasias were missed by D and C (12),(13).

There are studies which indicate that both polyps and hyperplasias are the risk factors for developing endometrial carcinoma (14),(15).

Endometrial cancer might be detected in women who undergo hysterectomy for benign conditions. This situation is best prevented by the careful evaluation of patients with abnormal uterine bleeding before definitive surgery. During curettage, the entire endometrium must be removed to make an accurate pathological diagnosis. A routine intra-operative opening of the hysterectomy specimen is advised to detect any evidence of endometrial cancer (16).

Endometrial cancer is the third most common malignancy of the female genital tract with an age-standardized incidence rate of 2.9 per 100,000 women. The highest rate accounts for 3.4 per 100,000 women (17).

Approximately 90% of the patients with endometrial carcinoma present with abnormal vaginal bleeding or discharge (18),(19). Any woman who is suspected of having endometrial cancer should undergo endometrial biopsy, fractional uterine curettage or biopsy under hysteroscopy for a definite diagnosis. Because of the 10% false-negative rate of an endometrial biopsy, a negative finding in a symptomatic woman must be further investigated by fractional curettage or hysteroscopy (18).

Material and Methods

A retrospective review of the archives of the Department of Pathology, Vinayaka Mission’s Kirupananda Variyar Medical College, Salem, from January 2005 to December 2009, who presented with DUB, were studied .131 cases of endometrial curettage and subsequent hysterectomy specimens were reviewed for histopathology and the results of the curettage specimens were compared to those of the hysterectomy specimens. The concordance and the disconcordance between fractional curettage and hysterectomy with respect to the dating of the endometrium, hyperplasias, and inadequate samples were studied by two pathologists. However, when comparing the dating of the endometrium, the results of the dating of fractional curretage were compared to that of the corresponding date of the hysterectomy and these were analyzed. However, the cases who received hormonal therapy were excluded.


A total of 131 cases with both fractional curettage and hysterectomyfrom January 2005 to December 2009, which were retrieved from the files of the Department of Pathology, Vinayaka Mission’s Kirupananda Variyar Medical College, Salem, were included in the study(Table/Fig 1).

Our cases ranged in ages from 28-65 years, with 63.3% cases falling between the age group of 36-45 years. All the cases presented with DUB. The mean duration between the curettage and hysterectomy in our study was 4.5 weeks, with a wide range of 1-24 weeks and the maximum cases falling between 1-5 weeks(Table/Fig 2).

Among the total 131 cases, 67 cases ( 51.1%) showed concordance between fractional curettage and hysterectomy. The concordance between fractional curettage and hysterectomy were analyzed by referring the dates of both the procedures for the cases which were dated for the endometrium as proliferative or secretory phase and was 42 ( 62.68%), concordance in hyperplasias were 25( 37.31%). Among the 25 cases which showed concordance, simple hyperplasias showed a concordance of (41.5%) as compared to complex hyperplasias (60%)(Table/Fig 3).

The number of cases which were coined as hyperplasias in the fractional curettage group was 44 cases and in the hysterectomy group, it was 40 cases with a concordance of 25 cases (37.31%). There were 19 cases of disconcordance of hyperplasias between fractional curettage and hysterectomy(Table/Fig 4).

Among the 19 disconcordance cases, those which were termed as hyperplasias in the fractional curettage group turned out to be proliferative and secretory endometrium (15 and 4 cases) respectively in the hysterectomy group(Table/Fig 5).

However, 4.58% of the cases which were inadequate in the fractional curettage group turned out to be proliferative (5 cases), and one case turned out to be moderately differentiated adenocarcinoma in the hysterectomy group.


Our study is the first study of its kind as it includes all the lesions like the phases of the endometrium, hyperplasias and carcinomas and these were compared between fractional curettage and hysterectomy in a single study without selecting a particular lesion as in the other studies.

All of our cases presented with DUB, which was much higher as compared to the cases in the studies which were done by Dangal G (20) (63% cases only). This pattern can be explained on the basis that most of our cases fell in the reproductive and the perimenopausal age group (36-45years). However, the studies which were done by Dangal G had most of their cases in the postmenopausal age group.

Fifty one percent (51%) of the total cases showed concordance between fractional curettage and hysterectomy and our cases also included a correlation between the endometrial phases and hyperplasia. However, the studies which were done by Xie X et al (10) assessed only the hyperplasia cases with a concordance of 62%, which explained that the cases with hyperplasia showed a greater concordance between fractional curettage and hysterectomy when they were correlated with the phases of the endometrium and carcinomas.

Our study revealed that the concordance between fractional curettage and hysterectomy in phasing the endometrium as proliferative and secretory was 63.62%, with a disconcordance of 35.38%. However, similar studies are not available for comparisonin the literature. However, the concordance between fractional curettage and hysterectomy were obtained by us by referring to the dates of both the procedures and these were analyzed later for the same.

A total of (37.3%) of the hyperplasia cases showed concordance between fractional curettage and hysterectomy in our study,19 cases termed as hyperplasia in fractional curettage turned out to be proliferative and secretory endometrium (15 and 4 cases) respectively. However studies by Somneuk et al showed a concordance of 41.3%.This low rate of concordance of endometrial hyperplasia can be explained, as most of our study population included were peri-menopausal women, and previous studies bySomneuk et al 10 have compared and proved that concordance are high in post-menopausal women than in peri-menopausal women.

On the comparison of each subtype of endometrial hyeperplasias, our study disclosed a concordance of 41.5% and 60 % in the simple and complex hyperplasias respectively, whereas the studies by Xie X et al showed a concordance of 88% and 92% for simple hyperplasia and complex hyperplasia respectively. These findings can be explained on the basis that most of our cases had a mean interval duration of 1-5 weeks between the curettage and hysterectomy ,whereas the studies by Somneuk et al (10) had a wide time duration of 1.4-34.9 weeks, which bought some time for the cases of endometrial hyeperplasias to regenerate before the hysterectomy.

Comparison of the cases within our study showed a reduced concordance in the cases of hyperplasia, because those cases which were quoted as simple hyperplasias were completely removed during the curettage, leaving behind the basal endometrium only, which was downgraded as a proliferative endometrium because of the short time gap between the curettage and hysterectomy. The complex hyperplasias with a higher degree of proliferation were not totally scraped out, thus rendering more number of patients with consistent histological findings, hence giving a high degree of concordance for complex hyperplasias.

Another possibility of the inconsistent diagnoses was the reproducibility of the tissue diagnosis as was mentioned by Trimble et al (10).

6(4.58 %) of our cases of curettage were not satisfactory for reporting and among them five cases were inadequate and one case was purely a blood clot which turned out to be proliferative and moderately differentiated adenocarcinoma on hysterectomy respectively. The studies by Elisabeth et al missed sixty percent of the complex atypical hyperplasias, 11% of the endometrial cancers, and one adenosarcoma by D and C.

Nevertheless, our results and those of Stovall (12) and Valle et al (13) suggested that both the benign and malignant pathologies may quite frequently be missed by D and C, hence laying more emphasis on hysterectomy.


Dysfunctional uterine bleeding was the commonest clinical presentation in the peri-menopausal age group. The cases of complex hyperplasia showed a higher concordance rate than those of simple hyperplasia, as the disconcordance between the endometrial curettages and the hysterectomy specimens remained high. Hence, they demanded awareness from the clinicians in not considering fractional curettage as the final diagnosis and instead to consider hysterectomy as the gold standard, especially in fractional curettage with the results of simple hyperplasias.


Ellenson L H,. Pirog E C. The Female Genital Tract in Kumar, Abbas, Fausto, Aster editor Robbins and Cotran Pathologic Basis of Disease;8th ed, W. B. saunder’s. 2010;
Coulter A, Klassen A, Meckenzie I Z, Mcpherson K. Diagnostic dialation and curettage; is it used appropriately ? BMJ 1993;306:236-9)3. (Royal College of Obstetricians and Gynaecologists. The management of menorrhagia in secondary care. Evidence based clinical guideline. No.5.London.RCOG press;1999)
Clayton RD. Hysterectomy. Best Practice and Research. Clinical Obstet Gynecol 2006; 20:73-87 .
Perveen S., Tayyaba S. Clinicopathological review of elective abdominal hysterectomy .J of Surgery Pakistan (International) 2008;13 (1): 26-9.
Rosai J,. Ackerman ed, Surgical Pathology, 9th ed ,vol-2 -2004 Mosby, page 1569
Takreem A, Danish N, Razaq S. Incidence of endometrial hyperplasia in 100 cases which presented with polymenorrhagia / menorrhagia in peri-menupausal women. J Ayub Med Coll Abbottabad 2009;21(2):
Ronnett BM, Kurman RJ: Precursor lesions of endometrial carcinoma. Blaustein’s Pathology of the Female Genital Tract, New York: Springer- Verlag: Kurman R 5;2002; 467–500.
Zaino RJ: Endometrial hyperplasia and carcinoma. Obstetrical and Gynaecological Pathology, Churchill Livingstone: Fox H, Haines, Taylor 5 2003; 1:445–6.
Mazur MT: Endometrial hyperplasia/adenocarcinoma. A conventional approach. Annals of Diagnostic Pathology 2005;9:174–81.
Jesadapatrakul S, Tangjitgamol S, Manusirivitaya S. Histopathologic consistency between endometrial hyperplasia diagnosis from endometrial curettage and pathological diagnoses from hysterectomy specimens. J Med Assoc Thai 2005; 88 (Suppl 2): S16-21)
Orbo A, Baak JPA, Kleivan I, Lysne S, Prytz PS, Broeckaert MAM, Slappendel A, Tichelaar HJ, et al. Computerised morphometrical analysis in endometrial hyperplasia for the prediction of cancer development. A long term retrospective study from northern Norway. Journal of Clinical Pathology 2000; 3:697–703.
Stovall TG, Solomon SK, Ling FW. Endometrial sampling prior to hysterectomy. Obstet Gynecol 1989; 73: 405–9.
Valle RF. Hysteroscopic evaluation of patients with abnormal uterine bleeding. Surg Gynecol Obstet 1981; 153: 521–6.
Sherman AI, Brown S. The precursors of endometrial carcinoma. Am J Obstet Gynecol 1979; 135: 947–56.
Pettersson B, Adami HO, Lindgren A, Hesselius I. Endometrial polyps and hyperplasia as the risk factors for endometrial carcinoma. A casecontrol study of curettage specimens. Acta Obstet Gynecol Scand 1985; 64: 653–9
Srisomboon J, Phongnarisorn C, Suprasert P. Endometrial cancer which was diagnosed in patients who were undergoing hysterectomy for benign gynecologic conditions. Thai Journal of Obstetrics and Gynaecology. March 2001; 13: 29-32-256.
Benjachai W. Corpus uteri. In: Deerasamee S, Martin N, Sontipong S, Sriamporn S, Sriplung H, Srivatanakul P, et al, editors. Cancer in Thailand Vol.II, 1992-1994. Lyon: IARC, 1999; 60-1
Hacker NF. Uterine cancer. In: Berek JS, Hacker NF,editors. Practical Gynecologic Oncology. 2nd ed.Baltimore : Williams and Wilkins, 1994; 285-326
Barakat RR, Park RC, Grigsby PW, Muss HD, Norris HJ. Corpus, et al. epithelial tumours. In: Hoskins WJ, Perez CA, Young RC, editors. Principles and Practice of Gynecologic Oncology. 2nd ed. Philadelphia: Lippincott-Raven, 1997; 859-96.
Dangal G1. A study on the endometrium of patients with abnormal uterine bleeding at Chitwan valley. Kathmandu University Medical Journal 2003; 1(2): 110-2 .

DOI and Others


JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)