Malignancy in endometrial polyps: a 12-year experience

Baiocchi, G.; Manci, Natalina; M, Pazzaglia; Giannone, Laura; Burnelli, Liliana; Giannone, E; Fratini, Daniela; Renzo, Gian Carlo Di

doi:10.1016/j.ajog.2009.05.055

Cited by 68 publications

(44 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…29,31,33,42 Similarly, hypertension was examined as an independent risk factor of malignancy within endometrial polyps by five authors who were included in this meta-analysis. 31,41 Based on our systematic review and meta-analysis, we conclude that among women with endometrial polyps, the presence of abnormal bleeding or menopausal status is associated with an increased risk of endometrial neoplasia. 31,41 Based on our systematic review and meta-analysis, we conclude that among women with endometrial polyps, the presence of abnormal bleeding or menopausal status is associated with an increased risk of endometrial neoplasia.…”

Section: Discussionmentioning

confidence: 84%

“…36 Four authors found no relationship between the two disease processes. 29,31,33,36,41 Savelli and Baiocchi were the only authors who reported a statistically significant association between these two disorders. 29,31,33,36,41 Savelli and Baiocchi were the only authors who reported a statistically significant association between these two disorders.…”

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

The Oncogenic Potential of Endometrial Polyps

Lee

Kaunitz²,

Sánchez-Ramos³

et al. 2010

Obstetrics & Gynecology

189

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 98%

The Oncogenic Potential of Endometrial Polyps

Lee

Kaunitz²,

Sánchez-Ramos³

et al. 2010

Obstetrics & Gynecology

189

View full text Add to dashboard Cite

show abstract

“…In general, upwards of 25% of women will be diagnosed with polyps at some point in their lives [43]. A number of studies have revealed that the overwhelming majority of polyps are clinically benign [43–45], 1.3%–6.0% are premalignant [45–48], 1.2%–3.9% display atypical hyperplasia [43,49,50], 10%–25.7% contain simple or complex endometrial hyperplasia [43,47,48], and 0.8%–3.5% are cancerous [43–45,51,52]. While polyps rarely become malignant, 10%–34% of cases of endometrial cancer in postmenopausal women are associated with polyps [53].…”

Section: Discussionmentioning

confidence: 99%

“…Only 1% of patients with simple hyperplasia progressed to carcinoma, 2.0%–3.4% of patients with complex hyperplasia progressed to carcinoma, 10.5% of patients with complex hyperplasia progressed to atypical hyperplasia, and 23%–52% of atypical hyperplasia cases progressed to carcinoma [55,56]. The advancement from simple to complex and atypical hyperplasia takes years and is potentially influenced by factors such as specific genetic aberrations, patient age, BMI, and menopausal status [45]. Given the relative risks, it is therefore necessary to correctly distinguish between the grading categories, because these have direct relevance to cancer development risk and, thus, potential overtreatment or undertreatment.…”

Section: Discussionmentioning

confidence: 99%

Genomic Analysis of Uterine Lavage Fluid Detects Early Endometrial Cancers and Reveals a Prevalent Landscape of Driver Mutations in Women without Histopathologic Evidence of Cancer: A Prospective Cross-Sectional Study

et al. 2016

View full text Add to dashboard Cite

BackgroundEndometrial cancer is the most common gynecologic malignancy, and its incidence and associated mortality are increasing. Despite the immediate need to detect these cancers at an earlier stage, there is no effective screening methodology or protocol for endometrial cancer. The comprehensive, genomics-based analysis of endometrial cancer by The Cancer Genome Atlas (TCGA) revealed many of the molecular defects that define this cancer. Based on these cancer genome results, and in a prospective study, we hypothesized that the use of ultra-deep, targeted gene sequencing could detect somatic mutations in uterine lavage fluid obtained from women undergoing hysteroscopy as a means of molecular screening and diagnosis.Methods and FindingsUterine lavage and paired blood samples were collected and analyzed from 107 consecutive patients who were undergoing hysteroscopy and curettage for diagnostic evaluation from this single-institution study. The lavage fluid was separated into cellular and acellular fractions by centrifugation. Cellular and cell-free DNA (cfDNA) were isolated from each lavage. Two targeted next-generation sequencing (NGS) gene panels, one composed of 56 genes and the other of 12 genes, were used for ultra-deep sequencing. To rule out potential NGS-based errors, orthogonal mutation validation was performed using digital PCR and Sanger sequencing.Seven patients were diagnosed with endometrial cancer based on classic histopathologic analysis. Six of these patients had stage IA cancer, and one of these cancers was only detectable as a microscopic focus within a polyp. All seven patients were found to have significant cancer-associated gene mutations in both cell pellet and cfDNA fractions. In the four patients in whom adequate tumor sample was available, all tumor mutations above a specific allele fraction were present in the uterine lavage DNA samples. Mutations originally only detected in lavage fluid fractions were later confirmed to be present in tumor but at allele fractions significantly less than 1%. Of the remaining 95 patients diagnosed with benign or non-cancer pathology, 44 had no significant cancer mutations detected. Intriguingly, 51 patients without histopathologic evidence of cancer had relatively high allele fraction (1.0%–30.4%), cancer-associated mutations. Participants with detected driver and potential driver mutations were significantly older (mean age mutated = 57.96, 95% confidence interval [CI]: 3.30–∞, mean age no mutations = 50.35; p-value = 0.002; Benjamini-Hochberg [BH] adjusted p-value = 0.015) and more likely to be post-menopausal (p-value = 0.004; BH-adjusted p-value = 0.015) than those without these mutations. No associations were detected between mutation status and race/ethnicity, body mass index, diabetes, parity, and smoking status. Long-term follow-up was not presently available in this prospective study for those women without histopathologic evidence of cancer.ConclusionsUsing ultra-deep NGS, we identified somatic mutations in DNA extracted both from cell pellets...

show abstract

“…Both age and BMI have been previously identifi ed as risk factors for malignancy in patients with endometrial polyps (Baiocchi et al 2009;Ferrazzi et al 2009;Savelli et al 2003;Antunes et al 2007;Ben-Arie et al 2004;Machtinger et al 2005;Gregoriou et al 2009). Th e menopause has also been found to be associated with a higher risk of cancer in endometrial polyps (Lee et al 2010), and all of the patients in our series except one were indeed postmenopausal (15/16, 93.8%).…”

Section: Endometrial Neoplasia In Women With Polyps At Ultrasound 613mentioning

confidence: 99%

Malignant and premalignant changes in the endometrium of women with an ultrasound diagnosis of endometrial polyp

Gambadauro

Martínez-Maestre

Schneider

et al. 2014

Journal of Obstetrics and Gynaecology

View full text Add to dashboard Cite

The association between polyps and endometrial cancer is under debate. The main objectives of this study were to study the frequency and the characteristics of malignant and premalignant endometrial changes in women with endometrial polyp at ultrasound. The study population consisted of 1,390 consecutive patients that were referred to office hysteroscopy because of the ultrasonographic diagnosis of endometrial polyps. A total of 16 cases of endometrial neoplasia were diagnosed (1.15%). The frequencies of atypia and cancer in our population were 0.14% and 1.01%, respectively. All patients, except one, were postmenopausal (93.8%). All had undergone the initial ultrasonographic assessment because of symptoms (bleeding in the 93.8%). The neoplasia was not confined to the polyp in 75% of the cases. Nine cases had a lower risk disease (56.25%; atypical hyperplasia or endometrial cancer stage IA-G1,2), while seven had a higher risk cancer (43.75%; ≥ stage IA-G3). Patients with a higher risk disease were found to be significantly younger, and their polyps were smaller, albeit non-significantly. In spite of the common practice to refer all women with an ultrasound diagnosis of polyp to hysteroscopy, our data show how the prevalence of endometrial neoplasia in these patients is low (1.15%). Moreover, the malignancy is not confined to a polyp in most of the cases.

show abstract

Malignancy in endometrial polyps: a 12-year experience

Cited by 68 publications

References 23 publications

The Oncogenic Potential of Endometrial Polyps

The Oncogenic Potential of Endometrial Polyps

Genomic Analysis of Uterine Lavage Fluid Detects Early Endometrial Cancers and Reveals a Prevalent Landscape of Driver Mutations in Women without Histopathologic Evidence of Cancer: A Prospective Cross-Sectional Study

Malignant and premalignant changes in the endometrium of women with an ultrasound diagnosis of endometrial polyp

Contact Info

Product

Resources

About