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Abstract and Introduction
Abstract
Objective: The aim of this study was to evaluate the prevalence of endometrial premalignant and malignant polyps in premenopausal and postmenopausal women, as well as the clinical, ultrasound, and hysteroscopic factors associated with malignancy.
Methods: All women undergoing hysteroscopic resection of endometrial polyps from January 1998 to December 2008 were selected using a computerized database from the operating theater of the Prof. Dr. José Aristodemo Pinotti Women's Hospital, Women's Health Care Center/University of Campinas. Eight hundred seventy women with ages ranging from 25 to 85 years were included. Polyps were classified into benign (endometrial polyps and polyps with nonatypical simple hyperplasia and nonatypical complex hyperplasia), premalignant (polyps with atypical simple hyperplasia or atypical complex hyperplasia), and malignant. Statistical analysis was performed by measurement of the frequencies, means, and SD. The risk factors for malignancy were assessed by bivariate and multiple regression analyses, using the Epi-Info 2000 program and SAS (Statistical Analysis Software), version 9.2.
Results: The mean (SD) age of the women was 57.5 (10.6) years. Of these women, 76.4% were postmenopausal. Women were diagnosed with benign lesions in 95.8% of cases. Premalignant polyps accounted for 1.6% of the total number of cases. Malignant polyps represented 2.5% of the total sample. Postmenopausal bleeding and age greater than 60 years were the only factors that remained associated with a higher risk of malignancy with a prevalence ratio of 3.67 (95% CI, 1.69–7.97) and 1.5 (95% CI, 1.01–1.09), respectively.
Conclusions: The prevalence rate of malignancy in endometrial polyps was higher in women with postmenopausal bleeding and advanced age.
Introduction
With the increased use of ultrasound, hysterosonography, and hysteroscopy in the evaluation of women with abnormal uterine bleeding or postmenopausal bleeding, the diagnosis of endometrial polyps has become more frequent in the last few years. The prevalence rate of endometrial polyps ranges from 10% to 40% in women with abnormal uterine bleeding, and polyps are found in up to 12% of asymptomatic women in routine examinations.
Endometrial polyps are defined as overgrowths of localized endometrial tissue. Polyps may be pedunculated or sessile, or single or multiple, ranging in size from a few millimeters to many centimeters. These lesions may contain varying amounts of stroma and blood vessels, covered by pseudostratified epithelium.
It is well known that the prevalence rate of malignancy associated with endometrial polyps ranges from 0.8% to 8%, depending on the sample analyzed and the resection methods used.
Previous studies have demonstrated a significant increase in the incidence of premalignant and malignant polyps in postmenopausal women older than 60 years who have associated vaginal bleeding Some studies have also observed an association with other risk factors for malignancy such as obesity, use of tamoxifen, arterial hypertension, and diabetes mellitus.
Hysteroscopy is considered the gold standard in the resection of endometrial polyps and evaluation of the endometrial cavity, allowing complete removal of the lesion and biopsy of suspicious areas in the adjacent endometrium. This method has a sensitivity of 97% and a specificity of 90% for the diagnosis of endometrial polyps, using histologic diagnosis of the biopsy as the gold standard. It surpasses exclusive use of ultrasound evaluation, with values of 41% and 83%, respectively.
Despite the low prevalence rate of malignancy, various women have undergone surgical procedures for the removal of polyps without a precise indication. Thus, it is imperative to determine which women are at greater risk so that a more judicious surgical indication for hysteroscopic resection of endometrial polyps can be made.
The aim of the study was to determine the prevalence of premalignant and malignant endometrial polyps in premenopausal and postmenopausal women. All women evaluated in this study underwent hysteroscopic resection of endometrial polyps and comprise one of the largest case studies investigating the topic in the literature. Furthermore, associations between clinical, ultrasound, and hysteroscopic factors as well as the risk of malignancy were evaluated.
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