Clinical parameters linked with malignancy in endometrial polyps

Gregoriou, O.; Konidaris, S.; Vrachnis, Nikolaos; Bakalianou, K; Salakos, N; Papadias, K; Kondi-Pafiti, Agathi; Creatsas, George

doi:10.1080/13697130902912605

Cited by 87 publications

(59 citation statements)

References 22 publications

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“…Obese women have higher levels of circulating estrogen which stimulate the endometrium to create endometrial polyps and probably malignant endometrial polyps [27].…”

Section: Resultsmentioning

confidence: 99%

“…Some authors have suggested that larger polyps are associated with a higher risk of malignancy [21,25]. However, others stated that polyp size is not a distinctive feature of malignancy [27,31]. A recently published meta-analysis concluded that the authors reported the size of polyps in centimeters, millimeters, grams, and milliliters, making the analysis of this association more difficult [32].…”

Section: Resultsmentioning

confidence: 99%

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Risk Factors Associated with the Malignant Changes of Symptomatic and Asymptomatic Endometrial Polyps in Premenopausal Women

Elfayomy

Soliman

2014

J Obstet Gynecol India

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Objective This study aimed to evaluate the prevalence of premalignant and malignant lesions of symptomatic and asymptomatic endometrial polyps among premenopausal women and to verify whether different clinical parameters, and polyp volume and number are associated with a more precise estimate of malignancy. Methods One hundred and fifty women aged 29-52 years and with certain diagnosis of endometrial polyp were enrolled in a prospective observational study. The recruited patients underwent hysteroscopic polypectomy based on saline infusion sonohysterography and diagnostic hysteroscopy. Pathologic report was the main outcome. Results Among women with endometrial polyps, 62 % had asymptomatic polyps. The prevalence of premalignant and malignant polyps comprised 4.6 % of cases (3.3 % hyperplasia with atypia and 1.3 % carcinomatous polyps). The presence of abnormal uterine bleeding was not a predictor of premalignant and malignant changes in the polyp. On logistic regression analysis, the premalignant and malignant lesions were influenced by polycystic ovary syndrome (p \ 0.001; OR 4.61; CI 1.9-27), polyp volume [10 ml (p \ 0.001; OR 5.83; CI 4.31-9.17), and multiple polyps (p = 0. 01; OR 2.05; CI 1.09-3.76). Notably, the odds ratio of polyp volume [10 ml was 5.83. This additional risk confirms the importance of polyp volume in the detection of malignant transformation rather than associating bleeding in premenopausal women. Conclusion Polycystic ovary syndrome, polyp volume greater than 10 ml, and increased polyp number represent the markers of risk for premalignant and malignant 123 transformation of endometrial polyps in premenopausal women. Nonetheless, the majority of polyps are asymptomatic, and the risk of malignancy is very low. Therefore, for women with polyp volume B10 ml and no risk factors, a more expectant approach may be warranted in order to reduce surgical risks and costs.

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“…Obese women have higher levels of circulating estrogen which stimulate the endometrium to create endometrial polyps and probably malignant endometrial polyps [27].…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Risk Factors Associated with the Malignant Changes of Symptomatic and Asymptomatic Endometrial Polyps in Premenopausal Women

Elfayomy

Soliman

2014

J Obstet Gynecol India

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“…Furthermore, it is considered to be a risk factor for the development of EPs themselves (21), and in particular appears to lead to malignant progression (22)(23)(24). In a study by Litta et al (25) a linear correlation between BMI and risk of malignancy in women with EPs was observed.…”

Section: Discussionmentioning

confidence: 99%

Thickness of preperitoneal fat as a predictor of malignancy in overweight and obese women with endometrial polyps

et al. 2016

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Abstract. The aim of the present study was to determine the association between the thickness of preperitoneal fat (PFT), utilized as an indicator of visceral fat deposition, and the risk of premalignant and malignant changes of endometrial polyps (EPs) in overweight and obese women. Overweight and obese women who had undergone diagnostic outpatient hysteroscopy and subsequent endometrial polypectomy between January 2010 and May 2013 were analyzed. Each patient underwent a transabdominal ultrasound for the purpose of measuring the thickness of preperitoneal fat. A total of 146 overweight or obese women were analyzed. The overall incidence of malignant or premalignant lesions was 8.2%. Notably, 5 patients (3.4%) received a histopathological diagnosis of complex hyperplasia with atypia, while polyps harboring carcinoma were diagnosed in 7 cases (4.8%). A significantly increased PFT was observed in women exhibiting preneoplastic and neoplastic lesions, compared with women with benign EPs (mean ± SD, 23.2±3.7 vs. 15.9±8.3; P<0.01). Patient age of >60 years was significantly associated with malignant progression of EPs, while body mass index, menopausal status, arterial hypertension, diabetes, abnormal uterine bleeding, hormone replacement therapy and tamoxifen treatment demonstrated no significant association with the development of preneoplastic and neoplastic lesions of the endometrium. In a multivariate analysis, only PFT maintained a significant correlation with the diagnosis of preneoplastic and neoplastic lesions on EPs (odds ratio, 1.14; 95% confidence interval, 1.04-1.26). Ultrasound evaluation of PFT in overweight and obese women may be useful for the identification of a particularly high-risk subgroup of women. Therefore, regardless of symptoms or additional clinical variables, these particularly high-risk women require appropriate counseling and prompt surgical removal of EPs.

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“…In four studies, larger polyps were directly associated with a greater risk of malignancy. According to Fernández-Parra et al 26 , Goldstein et al 3 , Shushan, Revel and Rojansky 27 , and Gregoriou et al 28 , polyp size did not represent a risk factor for malignancy. The authors highlight that in this meta-analysis, polyp size was reported in different units of measurement (centimeters, millimeters, or grams) and data were not amenable; these factors hindered the analysis of this association.…”

Section: Sensivitymentioning

confidence: 95%

Accuracy of sonography and hysteroscopy in the diagnosis of premalignant and malignant polyps in postmenopausal women

Godoy¹,

Antunes²,

Morais³

et al. 2013

Rev. Bras. Ginecol. Obstet.

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PURPOSE: To evaluate the accuracy of sonographic endometrial thickness and hysteroscopic characteristics in predicting malignancy in postmenopausal women undergoing surgical resection of endometrial polyps. METHODS: Five hundred twenty-one (521) postmenopausal women undergoing hysteroscopic resection of endometrial polyps between January 1998 and December 2008 were studied. For each value of sonographic endometrial thickness and polyp size on hysteroscopy, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated in relation to the histologic diagnosis of malignancy. The best values of sensitivity and specificity for the diagnosis of malignancy were determined by the Receiver Operating Characteristic (ROC) curve. RESULTS: Histologic diagnosis identified the presence of premalignancy or malignancy in 4.1% of cases. Sonographic measurement revealed a greater endometrial thickness in cases of malignant polyps when compared to benign and premalignant polyps. On surgical hysteroscopy, malignant endometrial polyps were also larger. An endometrial thickness of 13 mm showed a sensitivity of 69.6%, specificity of 68.5%, PPV of 9.3%, and NPV of 98% in predicting malignancy in endometrial polyps. Polyp measurement by hysteroscopy showed that for polyps 30 mm in size, the sensitivity was 47.8%, specificity was 66.1%, PPV was 6.1%, and NPV was 96.5% for predicting cancer. CONCLUSIONS: Sonographic endometrial thickness showed a higher level of accuracy than hysteroscopic measurement in predicting malignancy in endometrial polyps. Despite this, both techniques showed low accuracy for predicting malignancy in endometrial polyps in postmenopausal women. In suspected cases, histologic evaluation is necessary to exclude malignancy. ResumoOBJETIVO: Avaliar a acurácia da espessura endometrial ecográfica e características histeroscópicas em predizer malignidade em mulheres na pós-menopausa submetidas à ressecção cirúrgica de pólipos endometriais. MÉTODOS: Quinhentos e vinte e uma (521) mulheres na pós-menopausa submetidas à ressecção histeroscópica de pólipo endometrial entre janeiro de 1998 e dezembro de 2008 foram incluídas no estudo. Para cada valor de espessura endometrial ecográfica e tamanho dos pólipos na histeroscopia, a sensibilidade, a especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN) foram calculados em relação ao diagnóstico histológico de malignidade. Os melhores valores de sensibilidade e especificidade para o diagnóstico de malignidade foram determinados pela curva Receiver Operating Characteristic (ROC). RESULTADOS: O diagnóstico histológico identificou a presença de pré-malignidade ou malignidade em 4,1% dos casos. A espessura endometrial medida por ultrassonografia em casos de pólipos malignos foi maior quando comparado com pólipos benignos e pré-malignos. Na histeroscopia os pólipos malignos também foram maiores. A espessura endometrial de 13 mm mostrou uma sensibilidade de 69,6%, especificidade de 68,5%, VPP de 9,3% e VP...

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Clinical parameters linked with malignancy in endometrial polyps

Abstract: The prevalence of premalignant and malignant endometrial polyps is very low. Advanced age, menopause, obesity and diabetes increase the risk of endometrial polyp malignancy.

Cited by 87 publications

References 22 publications

Risk Factors Associated with the Malignant Changes of Symptomatic and Asymptomatic Endometrial Polyps in Premenopausal Women

Risk Factors Associated with the Malignant Changes of Symptomatic and Asymptomatic Endometrial Polyps in Premenopausal Women

Thickness of preperitoneal fat as a predictor of malignancy in overweight and obese women with endometrial polyps

Accuracy of sonography and hysteroscopy in the diagnosis of premalignant and malignant polyps in postmenopausal women

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