Pólipos endometriales: riesgo de malignización y correlación clínico-anatómica

Malignant Potential of Endometrial Polyps: A retrospective study

To estimate the potential risk of malignancy in endometrial polyps and to investigate the possible clinical risk factors. Clinical, sonographic, hysteroscopic and pathological data were reviewed of 337 women with pathologically confirmed endometrial polyps diagnosed in Qatar between 2000 and 2010. The polyps were benign in 95.6% of cases, pre-malignant in 2.3%, and malignant in 2.1 % of cases. Advanced age, menopausal status and vaginal bleeding were strongly associated with atypical hyperplasia and cancer. There appeared to be no association between the risk of malignancy and other clinical risk factors.

Conclusions: There is a small risk of malignancy in endometrial polyps, mainly in post-menopausal patients of advanced age with symptomatic vaginal bleeding. In these circumstances, endometrial polyps should be managed aggressively as potential cancer and removalfor histology is mandatory.

Endometrial polyps in pre- and postmenopausal women: Factors associated with malignancy

OBJECTIVE

To evaluate the prevalence of premalignant and malignant polyps and their association with menopausal status, hormone therapy and clinical characteristics in perimenopausal and postmenopausal women.

METHODS

A surgical database was used to select pre- and postmenopausal women >or=40 years of age, submitted to hysteroscopic resection of endometrial polyps. The medical records of 475 women were reviewed and clinical characteristics and histological diagnosis of resected polyps were assessed.

RESULTS

The majority of women had benign endometrial lesions, 78.53% of which were endometrial polyps and 13.47% polyps with simple or complex endometrial hyperplasia without atypia. Polyps with endometrial hyperplasia with atypia comprised 1.05% of cases, while 2.74% were carcinomatous polyps. Analysis using prevalence ratios showed that premalignant and malignant lesions were associated with age and postmenopausal bleeding. Women >60 years of age had a prevalence ratio 3.28 times greater (95%CI: 1.19-9.07) of premalignant or malignant polyps. When only postmenopausal women were evaluated for the effect of age, those over 60 years of age had a prevalence 5.31 times greater (95%CI: 1.22-23.09), while those with postmenopausal bleeding had an age-adjusted prevalence ratio of 3.71 (95%CI: 1.21-11.34) compared to asymptomatic women. No significant association was found between arterial hypertension, diabetes mellitus, obesity, use of hormone therapy or tamoxifen and premalignancy or malignancy.

CONCLUSIONS

There was a low prevalence of premalignant and malignant lesions in endometrial polyps. Older women and those with postmenopausal bleeding had a greater prevalence of malignancy and in these cases hysteroscopic resection of endometrial polyps is mandatory.

Hysteroscopic evaluation of endometrial polyps

OBJECTIVE

To establish the validity of hysteroscopy for predicting cancer in endometrial polyps based on their number, size and hysteroscopic appearance.

METHOD

Retrospective observational study of 653 women diagnosed hysteroscopically as having endometrial polyps. After outpatient or surgical hysteroscopic resection or resection following hysterectomy, the diagnosis was confirmed by histological examination. The incidence of cancer in women who had polyps was determined in the light of menopausal status, symptoms, size, number and appearance of the polyps.

RESULT

Carcinoma was found in only 3.9% of the women who consulted for menopausal metrorrhagia and were diagnosed as having a polyp. Hysteroscopy had a sensitivity of 36% and a specificity of 98% for a diagnosis of cancerous polyp or atypical hyperplasia.

CONCLUSION

The appearance and number of endometrial polyps seen by hysteroscopy may be useful in predicting cancer in the polyps, although resection and histological examination will still be necessary to confirm the diagnosis.