Suspecting malignancy in endometrial polyps: value of hysteroscopy

Area of Science:

• Gynecology
• Reproductive Medicine
• Pathology

Background:

• Endometrial polyps are common, and hysteroscopic polypectomy is standard for diagnosis and treatment.
• Debate exists regarding the optimal timing for hysteroscopic polypectomy, particularly for asymptomatic women with incidental findings.
• Accurate diagnosis of atypical hyperplasia and cancer on polyp surfaces is crucial.

Purpose of the Study:

• To evaluate the diagnostic accuracy of hysteroscopy and Vabra sampling for endometrial polyps.
• To determine the incidence of atypical hyperplasia and cancer on endometrial polyps.
• To identify clinical risk factors associated with malignant endometrial polyps.

Main Methods:

• Retrospective analysis of 1039 hysteroscopies and 345 women with endometrial polyps.
• All identified polyps underwent hysteroscopic polypectomy.
• Clinical data including age, menopausal status, abnormal uterine bleeding (AUB), and medication use were collected and analyzed.

Main Results:

• The incidence of endometrial hyperplasia or cancer on polyps was low (1.7%).
• Hysteroscopy demonstrated high accuracy in predicting malignancy (positive predictive value: 85.7%) and excellent exclusion (negative predictive value: 100%).
• Vabra sampling had a high inadequacy rate (38.5%). Age over 60 and postmenopausal AUB significantly increased the risk of malignancy.

Conclusions:

• Diagnostic hysteroscopy is a reliable tool for predicting malignancy in the epithelial layer of endometrial polyps.
• Advanced age (over 60) and abnormal uterine bleeding are significant risk factors for malignant endometrial polyps.
• Surgical resection is recommended for suspicious endometrial polyps.