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Published on: August 2, 2024
Beyond Size: The Impact of Endometrial Polyp Location on Malignancy Risk
Ismail Baglar1, Fatih Sanlikan2, Esra Keles2
1Department of Obstetrics and Gynecology, Kartal Lütfi Kırdar City Hospital, University of Health Sciences Turkey, Istanbul, Turkey, ismailbg@gmail.com.
Objectives:
The aim of the study was to evaluate whether endometrial polyp localization is associated with premalignant/malignant histopathology and to compare clinical and morphological characteristics between benign and premalignant/malignant polyps.
Design:
This is a single-center retrospective observational study. Participants/Materials: A total of 580 women who underwent hysteroscopic polypectomy with subsequent histopathological evaluation were included.
Setting:
The study was conducted at a tertiary referral center between January 2010 and December 2024.
Methods:
Polyps were categorized according to hysteroscopic localization (fundal, anterior wall, posterior wall, cornual, lower uterine segment). Cases were grouped as benign versus premalignant/malignant based on histopathology. Demographic variables (age, menopausal status), clinical presentation (abnormal uterine bleeding), and morphological parameters (polyp size, endometrial thickness) were compared. A multivariate logistic regression model including age, menopausal status, abnormal uterine bleeding, polyp size, endometrial thickness, and polyp localization was used to identify independent predictors.
Results:
Most polyps were fundal (31.0%), anterior wall (24.3%), or posterior wall (21.0). Premalignant/malignant pathology was detected in 6.4% of cases and occurred more frequently in fundal and cornual localizations. Compared with the benign group, the premalignant/malignant group had a higher mean age (56.7 ± 8.1 vs. 48.9 ± 9.4 years) and a higher proportion of postmenopausal women (78.9 vs. 37.5%). Abnormal uterine bleeding was more common in premalignant/malignant cases (94.7 vs. 61.3%). Median polyp size was larger (18 mm [7-38] vs. 12 mm [4-34]) and mean endometrial thickness was greater (15.2 ± 5.1 mm vs. 10.1 ± 4.6 mm). In multivariate analysis, fundal (OR 2.18, 95% CI: 1.02-4.66) and cornual localization (OR 2.87, 95% CI: 1.21-6.79) remained independently associated with premalignant/malignant pathology.
Limitations:
This is a retrospective, single-center design; results depend on the completeness and accuracy of hysteroscopic records. Data regarding tamoxifen and hormone replacement therapy use were not available.
Conclusions:
Beyond established risk factors, fundal and cornual localization of endometrial polyps is independently associated with premalignant/malignant pathology. Localization may add clinical value to risk stratification during hysteroscopic assessment.
