Risk of cancer in symptomatic postmenopausal women with endometrial polyps at scan

Postmenopausal bleeding is a common symptom accounting for about 10% of gynaecology referrals. Endometrial polyp formation is a frequent association and most can be identified at transvaginal scan using fluid-contrast endosonography. We undertook a study to find out what proportions of polyps are malignant or pre-malignant, and of those, what proportion could be identified on outpatient endometrial sampling. A consecutive series of 102 women were identified from theatre records and a cancer registry. The results suggest that about 10% of women with benign polyps get a further lesion. Overall, 11 (10.8%) had cancer and two (1.9%) had severe pre-malignant changes (complex endometrial hyperplasia with atypia). Of the 11 cancers, six (54.5%) were identified on endometrial sampling but five (45.5%) were only evident after inpatient hysteroscopic removal of the polyp. Four of these (80%) had had benign tissue on initial endometrial microscopy.