BACKGROUND AND PURPOSE:

• Incidence of endometrial carcinoma is high (approximately 40%) in women who undergo hysterectomy following a random endometrial biopsy
• Jacobs et al. (BJOG, 2020) investigated the incidence of endometrial carcinoma in patients diagnosed with atypical hyperplasia confined to a polyp

METHODS:

• Retrospective cohort study (2008 to 2016)
• Participants
  • Women who had hysteroscopic polyp resection
  • Notes documented complete polyp removal
• Data collection
  • Patient characteristics: Age | BMI | Menopausal status | Hormone use | Symptoms at presentation (pre- and postmenopausal bleeding)
  • Polyps reported as incidental findings or following investigation for abdominal pain or vaginal discharge were considered asymptomatic  
  • Histopathology results of the polyp
  • Histopathology results of the uterus, in the case of hysterectomy
• Polyps divided into two groups
  • Benign polyps
  • (Pre‐)malignant polyps: Atypical hyperplasia or endometrial carcinoma
• Primary outcome
  • Endometrial carcinoma

RESULTS:

• 1,445 polyp resections
  • Benign histopathology results: 96.2% (1,390 polyps)
  • (Pre‐)malignant: 3.8% (55 polyps)
    • Atypical hyperplasia: 2.7% (39 polyps)
    • Endometrial carcinoma: 1.1% (16 polyps)
• Hysterectomy (indication for (pre‐)malignant polyp pathology result for the polyp: 50 cases
  • Atypical hyperplasia confined to polyp: 35 cases
  • Endometrial carcinoma confined to the polyp: 15 cases
• Endometrial histopathology among the 35 women with atypical hyperplasia confined to the polyp
  • No additional pre-malignant changes in the endometrium: 30.8% (12 women)
  • Atypical hyperplasia: 28.2% (11 women)
  • Endometrial carcinoma: 30.8% (12 women)
• Older age, postmenopausal status, tamoxifen use or bleeding at presentation were not associated with whether a polyp had  (pre‐)malignant changes

CONCLUSION:

• Endometrial carcinoma was found in 30.8% of hysterectomy specimens performed for atypical hyperplasia confined to a polyp
• The authors conclude that the data in this study supports a recommendation “to perform a hysterectomy and bilateral salpingo-oophorectomy for polyps with confined atypical hyperplasia in postmenopause and surgery or progestogens in premenopausal women”

Learn More – Primary Sources:

Atypical endometrial polyps and the incidence of endometrial cancer: a retrospective cohort study

Related ObG Topics: