Prevalence and predictors of atypical histology in endometrial polyps removed by hysteroscopy: A secondary analysis from the SICMIG hysteroscopy trial

Facts Views Vis ObGyn 2019;11(2):127-134

1. Department of Obstetrics and Gynecology, Lodi Hospital, Italy;

2. Department of Gynecology, Istituto Clinico Città Studi, Milan, Italy;

3. Department of Obstetrics and Gynecology, DSC L. Sacco, Milan, Italy;

4. Department of Gynecology, Mauriziano Umberto I Hospital, Turin, Italy;

5. Department of Obstetrics and Gynecology, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy;

6. Department of Biostatistics, Oslo Center for Biostatistics and Epidemiology, University of Oslo, Norway;

7. Department of Obstetrics and Gynecology, University of Cagliari, Italy;

8. Department of Women’s and Children’s Health, University of Padua, Italy;

9. Department of Obstetrics and Gynecological, Urological Sciences and Reproductive Medicine, University “Federico II” of Naples, Italy;

10. Department of Minimally Invasive and Oncological Surgery, Casa di cura Città di Parma, Italy;

11. Department of Women’s Health and Territorial Medicine, University of Rome “La Sapienza”, Rome, Italy;

12. Department of Medical and Surgical Sciences, University of Foggia, Italy;

13. Department of Obstetrics , Gynecology and Neonatology, University of Bari, Italy;

14. Department of Obstetrics and Gynecology, University of Bologna, Italy;

15. Department of Obstetrics and Gynecology, University of Turin, Italy;

16. Department of Obstetrics and Gynecology, Treviso Hospital, Treviso, Italy;

17. Department of Day Surgery, Palagi Hospital, Florence, Italy;

18. Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy;

19. Department of Obstetrics and Gynecology, University of Pisa, Italy; 20 Department of Obstetrics and Gynecology, Pistoia Hospital, Italy

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Abstract

Background

The aim of this study is to assess the prevalence of atypical hyperplasia (AH) and endometrial cancer (EC) within endometrial polyps (EPs) removed by hysteroscopy.

Methods

Hysteroscopic polypectomy interventions were performed over 1436 consecutive patients with Eps to complete a prospective observational trial (Canadian Task Force Classification II-2) including 19 Italian Gynecologic Departments (University-Affiliated or Public Hospitals) for a secondary multicenter analysis.

Results

At histological analysis, in 1404 patients (97.8%) EPs were classified as benign, whereas in 32 patients (2.2%) EPs were diagnosed as atypical (i.e. with AH or EC). Specifically, AH and EC were found in 17 (1.2%) and 15 (1.0%) cases, respectively. Risk factor analysis showed that menopausal status, BMI and size of EPs were associated with increased risk of atypical EPs (p<0.0001). Abnormal uterine bleeding, EPs number, contraceptive therapy and tamoxifen were not associated with increased risk of atypia (p=ns). The cut-off points for increased risk of atypical polyps were 54.2 years old, BMI of 25.3 and EP size of 2.2 cm. Hysterectomy specimens were analyzed in 21 women with atypical EPs, showing the concomitant presence of atypical tissue in non-polypoid endometrium in the majority of patients (n=14 women, 66.6%).

Conclusion

The prevalence of endometrial cancer and atypical hyperplasia in endometrial polyps is low, although it is increased in women who are overweight, older than 54 years of age or with a polyp larger than 2cm.

Keywords:

Endometrial polyp, Atypical hyperplasia, Endometrial cancer, Hysteroscopy, Polypectomy