Anatomopathological study of endometrial polyps diagnosed by hysteroscopy

Abstract

The incidence of malignancy in polypoid formations of the endometrium has been recently studied in several countries and it is shown to be between 0 and 4.8% in most studies. The increasing use of transvaginal ultrasonography, even in asymptomatic women, has increased the frequency of this diagnosis in our country. Several studies recommend the excision and histological evaluation of all the polypoid lesions visualized on the hysteroscopic examination in order to exclude malignancy, although this approach is not consensual (especially when the patients are young or asymptomatic). The present study evaluated 458 results of anatomopathological exams of specimens with hysteroscopic diagnosis of endometrial polyps, admitted to a general pathology laboratory. Hysteroscopic diagnosis was confirmed in 79.9% of  the cases (76.0–83.3%, 95%CI) and the prevalence of adenocarcinoma was 5.25% (3.7–7.9%, 95%CI) in all the exams. Cellular  atypia in simple or complex glandular hyperplasia was identified in 1.9% of all endometrial polyps (0.9–3.8%, 95%CI). Age greater than or equal to 51 years behaved as a variable strongly associated with a higher prevalence of malignant and premalignant lesions, which in this group represented 12.2% of diagnoses. Compared to the group of patients aged between 41 and 50 years, the prevalence ratio was 2.96, with OR=3.23. The prevalence of 6.99% of premalignant and malignant lesions found in the general population of this study justifies the recommendation of hysteroscopic excision and histopathological examination of any findings in the endometrial cavity, regardless of their size or benign macroscopic aspect.